Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 056614 | NY |
NPI | 1144669219 |
---|---|
Provider Name | Dr. Dara Lee |
First Address | New York, NY 10010-4020 |
Second Address | New York, NY 10010-4020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 28/03/2014 |