Provider Demographics
NPI:1124336623
Name:SANG M LEE, MD PA
Entity type:Organization
Organization Name:SANG M LEE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-560-3560
Mailing Address - Street 1:65 MOUNTAIN BLVD. EXT.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2633
Mailing Address - Country:US
Mailing Address - Phone:732-560-3560
Mailing Address - Fax:732-560-3565
Practice Address - Street 1:65 MOUNTAIN BLVD EXT.
Practice Address - Street 2:SUITE 206
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2633
Practice Address - Country:US
Practice Address - Phone:732-560-3560
Practice Address - Fax:732-560-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA028796002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12905Medicare UPIN
LE082529Medicare PIN