Healthcare Provider Details

I. General information

NPI: 1073503033
Provider Name (Legal Business Name): WOONG LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK ST
GLENS FALLS NY
12801-4413
US

IV. Provider business mailing address

PO BOX 761
LATHAM NY
12110-0761
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-3838
  • Fax:
Mailing address:
  • Phone: 800-357-4829
  • Fax: 518-786-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number117623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: