Provider Demographics
NPI:1033166582
Name:LEE, JOO YOUNG MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:JOO YOUNG
Middle Name:MELISSA
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37 NO FULLERTON AVENUE
Mailing Address - Street 2:JOO YOUNG MELISSA LEE MD
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3426
Mailing Address - Country:US
Mailing Address - Phone:973-509-1818
Mailing Address - Fax:973-509-0708
Practice Address - Street 1:37 NO FULLERTON AVENUE
Practice Address - Street 2:MONTCLAIR BREAST CENTER
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3426
Practice Address - Country:US
Practice Address - Phone:973-509-1818
Practice Address - Fax:973-509-0708
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA075950002085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071931QP4Medicare ID - Type Unspecified
H75236Medicare UPIN