Provider Demographics
NPI:1891843447
Name:LEE, THOMAS G (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:297 WESTWOOD DR
Mailing Address - Street 2:#102
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3144
Mailing Address - Country:US
Mailing Address - Phone:856-845-2400
Mailing Address - Fax:856-845-2401
Practice Address - Street 1:297 WESTWOOD DR
Practice Address - Street 2:#102
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3144
Practice Address - Country:US
Practice Address - Phone:856-845-2400
Practice Address - Fax:856-845-2401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00624700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
077787Medicare ID - Type Unspecified