Provider Demographics
NPI:1164446126
Name:LEE, NAN-YI MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAN-YI
Middle Name:MICHAEL
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2137
Mailing Address - Country:US
Mailing Address - Phone:973-994-1646
Mailing Address - Fax:973-994-4887
Practice Address - Street 1:1000 S ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3100
Practice Address - Country:US
Practice Address - Phone:908-436-0100
Practice Address - Fax:908-436-0295
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ224861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice