Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 287639 | NY |
NPI | 1003158759 |
---|---|
Provider Name | Dr. Jennifer Yang Lee |
First Address | Bayside, NY 11364-3241 |
Second Address | Bayside, NY 11364-3241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 08/01/2019 |