Provider Demographics
NPI:1609068659
Name:LEE, YOUNG J. (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG J.
Middle Name:
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 1:1030 KINGS N HWY 200
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1907
Mailing Address - Country:US
Mailing Address - Phone:856-779-7774
Mailing Address - Fax:856-779-0211
Practice Address - Street 1:2 8TH ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-3347
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:856-779-0211
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08184600207LP2900X, 207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0154652Medicaid
NJ124086X8NMedicare PIN
NJ0154652Medicaid