Individual
JACOB S LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
72 W JIMMIE LEEDS RD, SUITE 1100, GALLOWAY, NJ 08205-9406
(609) 677-9729
(609) 652-7153
Mailing address
72 W JIMMIE LEEDS RD, SUITE 1100, GALLOWAY, NJ 08205-9406
(609) 677-9729
(609) 652-7153
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
25MA07860300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073989
—
NJ
01
—
P00280613
RAILROAD MEDICARE
NJ
01
—
P00758330
RAILROAD MEDICARE
NJ
01
—
P00847798
RAILROAD MEDICARE
NJ
Enumeration date
08/28/2006
Last updated
04/05/2012
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