Provider Demographics
NPI:1225118771
Name:YASGUR, LEE H (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:H
Last Name:YASGUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 ROBIN LAKE DRIVE
Mailing Address - Street 2:CHERRY HILL
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-429-0997
Mailing Address - Fax:856-429-4799
Practice Address - Street 1:1415 RT 70 EAST
Practice Address - Street 2:CHERRY HILL
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2210
Practice Address - Country:US
Practice Address - Phone:856-429-0997
Practice Address - Fax:856-429-4799
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA039265207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2401002Medicaid
C57096Medicare UPIN
093558Medicare ID - Type Unspecified
NJ2401002Medicaid