Provider Demographics
NPI:1356971246
Name:LEE, YONGSOO (NP-C)
Entity type:Individual
Prefix:
First Name:YONGSOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 LIBERTY ST APT 49
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1368
Mailing Address - Country:US
Mailing Address - Phone:316-708-9379
Mailing Address - Fax:
Practice Address - Street 1:291 LIBERTY ST APT 49
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1368
Practice Address - Country:US
Practice Address - Phone:316-708-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01009600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner