Provider Demographics
NPI:1417924622
Name:LEE, CHI I
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:I
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:I
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1525
Mailing Address - Country:US
Mailing Address - Phone:732-264-4900
Mailing Address - Fax:732-739-2201
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-4900
Practice Address - Fax:732-739-2201
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA031464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06457Medicare UPIN