Provider Demographics
NPI:1700826856
Name:LEE, ISIDORE (MD)
Entity Type:Individual
Prefix:DR
First Name:ISIDORE
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 1:2 SUMMERHILL DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5149
Mailing Address - Country:US
Mailing Address - Phone:908-769-8272
Mailing Address - Fax:908-753-0816
Practice Address - Street 1:2 SUMMERHILL DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5149
Practice Address - Country:US
Practice Address - Phone:908-769-8272
Practice Address - Fax:908-753-0816
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA033542207L00000X
NY128132207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP01046550OtherRR MCR
NJ2411202Medicaid
NJD18438Medicare UPIN
NJ028639Medicare ID - Type Unspecified
NJP01046550OtherRR MCR