Provider Demographics
NPI:1942244827
Name:LEE, JEN F (MD)
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:F
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 1:3 UNIVERSITY PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6208
Mailing Address - Country:US
Mailing Address - Phone:201-833-3000
Mailing Address - Fax:
Practice Address - Street 1:730 PALISADE AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3144
Practice Address - Country:US
Practice Address - Phone:201-353-9000
Practice Address - Fax:201-530-0003
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06737800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8105308Medicaid
NJ8105308Medicaid