Provider Demographics
NPI:1316367519
Name:TANTRAL, LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:TANTRAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3625
Mailing Address - Country:US
Mailing Address - Phone:718-928-4486
Mailing Address - Fax:908-994-5574
Practice Address - Street 1:225 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3625
Practice Address - Country:US
Practice Address - Phone:718-928-4486
Practice Address - Fax:908-994-5574
Is Sole Proprietor?:No
Enumeration Date:2014-04-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11676900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine