Healthcare Provider Details

I. General information

NPI: 1881542769
Provider Name (Legal Business Name): LY LEE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 61ST ST STE 403
BROOKLYN NY
11220-5163
US

IV. Provider business mailing address

24935 THEBES AVE
LITTLE NECK NY
11362-1335
US

V. Phone/Fax

Practice location:
  • Phone: 718-909-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312738
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: