Provider Demographics
NPI:1871983197
Name:LEE AESTHETIC CENTER, LLC
Entity type:Organization
Organization Name:LEE AESTHETIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-896-0566
Mailing Address - Street 1:58 MOUNT BETHEL RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2654
Mailing Address - Country:US
Mailing Address - Phone:908-738-1160
Mailing Address - Fax:908-738-1170
Practice Address - Street 1:58 MOUNT BETHEL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2654
Practice Address - Country:US
Practice Address - Phone:908-738-1160
Practice Address - Fax:908-738-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09441300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty