Provider Demographics
NPI:1952412678
Name:GARDNER, LEE ROBBINS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ROBBINS
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E PALISADE AVE APT A9
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2200
Mailing Address - Country:US
Mailing Address - Phone:201-394-2989
Mailing Address - Fax:201-567-7947
Practice Address - Street 1:151 E PALISADE AVE APT A9
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2200
Practice Address - Country:US
Practice Address - Phone:201-394-2989
Practice Address - Fax:201-567-7947
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA213902084P0804X, 2084P0800X
NY084218-12084P0804X, 2084P0800X
NJ25MA02139000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54582Medicare UPIN