Provider Demographics
NPI:1982692745
Name:LEE, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
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 1:24 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1902
Mailing Address - Country:US
Mailing Address - Phone:201-784-0123
Mailing Address - Fax:201-784-0065
Practice Address - Street 1:24 ELM ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1902
Practice Address - Country:US
Practice Address - Phone:201-784-0123
Practice Address - Fax:201-784-0065
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06619700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5251548OtherAETNA PPO #
NJ110238811OtherRAILROAD MDCR #
NJ3458089OtherAETNA HMO #
NJ056AO2OtherEMPIRE HC (TE) #
NJ056AO3OtherEMPIRE HC (HP) #
NJ056AO1OtherEMPIRE HC (HP) #
NJ2K2175OtherHEALTHNET #
NJ0011445000OtherAMERIHEALTH #
NJP815754OtherOXFORD #
NJ056AO3OtherEMPIRE HC (HP) #
NJP815754OtherOXFORD #