Provider Demographics
NPI:1144226028
Name:LEE, S HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:HOWARD
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 ROUTE 22 EAST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-3002
Mailing Address - Country:US
Mailing Address - Phone:732-968-4899
Mailing Address - Fax:732-968-8096
Practice Address - Street 1:201 UNION AVE
Practice Address - Street 2:BLDG 2
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3002
Practice Address - Country:US
Practice Address - Phone:908-725-1291
Practice Address - Fax:908-725-8335
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03350300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ300102252OtherRAILROAD MEDICARE - SMC
NJ300009501OtherRAILROAD MEDICARE - EDISON
NJ300025885OtherRAILROAD MEDICARE - BRIDGEWATER
NJ5135508Medicaid
NJ300102252OtherRAILROAD MEDICARE - WARREN
NJE75327Medicare UPIN
NJ5135508Medicaid