Provider Demographics
NPI:1821183567
Name:LEE, CASEY K (MD)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:K
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 1:200 SO. ORANGE AVE
Mailing Address - Street 2:SUITE 180 ANNEX
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-226-2725
Mailing Address - Fax:973-226-3270
Practice Address - Street 1:200 SO. ORANGE AVE
Practice Address - Street 2:SUITE 180 ANNEX
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-226-2725
Practice Address - Fax:973-226-3270
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA027294207XS0117X
NJ25MA02729400207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F12539OtherHEALTHNET
ES545OtherOXFORD
DO6286Medicare UPIN
ES545OtherOXFORD
188148M34Medicare ID - Type Unspecified