Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 050790 | NY |
Y | 213EG0000X | General Practice | 050790 | NY |
NPI | 1003006529 |
---|---|
Provider Name | Dr. Joon Seung Lee |
First Address | Fort Lee, NJ 07024-7025 |
Second Address | Brooklyn, NY 11228-2305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 31/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02722636 | (05) | NY |