Provider Demographics
NPI:1558367821
Name:LEE, EDWARD G (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOSPITAL PLZ
Mailing Address - Street 2:STE 405
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3096
Mailing Address - Country:US
Mailing Address - Phone:732-946-2844
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:STE 405
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3096
Practice Address - Country:US
Practice Address - Phone:732-360-1133
Practice Address - Fax:732-360-0033
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04835600207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0741001Medicaid
NJ5503110OtherGHI INS
NJ0102139000OtherKEYSTONE INS
NJ223397264OtherCIGNA INS
NJ0025721OtherAETNA INS
NJ0845602004OtherAMERIHEALTH INS
NJLS156OtherOXFORD
NJOK7620OtherHEALTHNET
NH1041554OtherHORIZON NJ HEALTH
NJ290001803OtherRAILROAD MEDICARE
NJ1081701OtherHORIZON NJ SPECIALIST
NJ290001803OtherRAILROAD MEDICARE
NJ0741001Medicaid