Provider Demographics
NPI:1962014589
Name:LEE, SCOTT HYEONHO
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:HYEONHO
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BALDWIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2010
Mailing Address - Country:US
Mailing Address - Phone:973-939-2691
Mailing Address - Fax:973-939-2693
Practice Address - Street 1:200 BALDWIN RD STE 200
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2010
Practice Address - Country:US
Practice Address - Phone:973-939-2691
Practice Address - Fax:973-939-2693
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03985800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist