Provider Demographics
NPI:1619151842
Name:LEE, YU-PING (PA)
Entity Type:Individual
Prefix:
First Name:YU-PING
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C, PHARMD, MS
Mailing Address - Street 1:1005 N. WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-3339
Mailing Address - Country:US
Mailing Address - Phone:732-968-8900
Mailing Address - Fax:732-968-4609
Practice Address - Street 1:1005 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2619
Practice Address - Country:US
Practice Address - Phone:732-968-8900
Practice Address - Fax:732-968-4609
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012016-1363A00000X
NJ25MP00228200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant