Provider Demographics
NPI:1235294364
Name:J JENNIFER LEE OD PC
Entity Type:Organization
Organization Name:J JENNIFER LEE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIYONG
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-561-6333
Mailing Address - Street 1:671 POMONA AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3825
Mailing Address - Country:US
Mailing Address - Phone:856-428-9022
Mailing Address - Fax:
Practice Address - Street 1:421 S EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1417
Practice Address - Country:US
Practice Address - Phone:609-561-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA005657261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center