Provider Demographics
NPI:1851896096
Name:LEE, JOHN S (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:S
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:14 RIVER STREET EXT APT 233
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1126
Mailing Address - Country:US
Mailing Address - Phone:845-304-1406
Mailing Address - Fax:
Practice Address - Street 1:420 74TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2602
Practice Address - Country:US
Practice Address - Phone:646-974-8723
Practice Address - Fax:877-540-0077
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00361300213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty