Provider Demographics
NPI:1386688083
Name:LEE, SERENA QIQIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:QIQIN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:748 ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3401
Mailing Address - Country:US
Mailing Address - Phone:973-335-9210
Mailing Address - Fax:973-335-9240
Practice Address - Street 1:1222 ROUTE 46 WEST
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2158
Practice Address - Country:US
Practice Address - Phone:973-335-9210
Practice Address - Fax:973-335-9240
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA061583207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6750605Medicaid
NJG19504Medicare UPIN
NJ812670Medicare ID - Type Unspecified