Provider Demographics
NPI:1194601245
Name:LEE, YEO JIN (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:YEO JIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-2706
Mailing Address - Country:US
Mailing Address - Phone:551-574-2382
Mailing Address - Fax:
Practice Address - Street 1:83 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-2706
Practice Address - Country:US
Practice Address - Phone:551-574-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2024061398363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care