Provider Demographics
NPI:1508891003
Name:WILLIAM K LEE MD PA
Entity Type:Organization
Organization Name:WILLIAM K LEE MD PA
Other - Org Name:CARDIAC ASSOCIATES OF NORTH JERSEY PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-337-0066
Mailing Address - Street 1:43 YAWPO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436
Mailing Address - Country:US
Mailing Address - Phone:201-337-0066
Mailing Address - Fax:201-337-7417
Practice Address - Street 1:43 YAWPO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436
Practice Address - Country:US
Practice Address - Phone:201-337-0066
Practice Address - Fax:201-337-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06243600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8614202Medicaid
NJ8614202Medicaid
G19663Medicare UPIN