Provider Demographics
NPI:1568439875
Name:LEE, ANGIE (MD)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 23831
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0001
Mailing Address - Country:US
Mailing Address - Phone:973-971-7185
Mailing Address - Fax:
Practice Address - Street 1:870 POMPTON AVE
Practice Address - Street 2:UNIT A-1
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1203
Practice Address - Country:US
Practice Address - Phone:973-239-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07575800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072127AUKMedicare ID - Type Unspecified
NJH91278Medicare UPIN