Provider Demographics
NPI:1700321122
Name:LEE, YOUNG H
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:H
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 1:40 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2245
Mailing Address - Country:US
Mailing Address - Phone:201-567-0006
Mailing Address - Fax:201-567-0014
Practice Address - Street 1:40 CENTER ST
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2245
Practice Address - Country:US
Practice Address - Phone:201-567-0006
Practice Address - Fax:201-567-0014
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00122500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist