Healthcare Provider Details

I. General information

NPI: 1578422531
Provider Name (Legal Business Name): KATHERINE LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BEACH 19TH ST
FAR ROCKAWAY NY
11691-4423
US

IV. Provider business mailing address

3 GARFIELD AVE
FARMINGDALE NY
11735-3308
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-7000
  • Fax:
Mailing address:
  • Phone: 516-252-7169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: