Provider Demographics
NPI:1760053482
Name:MATTHEW LEE DDS NJ PC
Entity Type:Organization
Organization Name:MATTHEW LEE DDS NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-860-5085
Mailing Address - Street 1:26 AVE AT PORT IMPERIAL APT 101
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3198
Mailing Address - Country:US
Mailing Address - Phone:917-860-5085
Mailing Address - Fax:
Practice Address - Street 1:225 BROAD AVE STE 102
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1589
Practice Address - Country:US
Practice Address - Phone:201-658-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental