Provider Demographics
NPI:1700232816
Name:LEE, JOSIE
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 SOUTH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1373
Mailing Address - Country:US
Mailing Address - Phone:908-288-7682
Mailing Address - Fax:
Practice Address - Street 1:346 SOUTH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1373
Practice Address - Country:US
Practice Address - Phone:908-288-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00638400163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)