Provider Demographics
NPI:1760794796
Name:LEE, DIANA (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 N LAKEVIEW DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1026
Mailing Address - Country:US
Mailing Address - Phone:856-435-6000
Mailing Address - Fax:856-782-1667
Practice Address - Street 1:63 N LAKEVIEW DR
Practice Address - Street 2:SUITE 202
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1026
Practice Address - Country:US
Practice Address - Phone:856-435-6000
Practice Address - Fax:856-782-1667
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08721800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics