Provider Demographics
NPI:1578617338
Name:LEE, YOUNG I (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:I
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 1:2263 ST GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065
Mailing Address - Country:US
Mailing Address - Phone:732-574-0055
Mailing Address - Fax:732-574-1155
Practice Address - Street 1:2263 ST GEORGE AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-574-0055
Practice Address - Fax:732-574-1155
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ028327207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2394103Medicaid
NJ460418Medicare PIN
D19774Medicare UPIN
NJX8460418Medicare PIN