Healthcare Provider Details

I. General information

NPI: 1073454013
Provider Name (Legal Business Name): TAEOK LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CUTTERMILL RD FL 2
GREAT NECK NY
11021-3102
US

IV. Provider business mailing address

103 CUTTERMILL RD FL 2
GREAT NECK NY
11021-3102
US

V. Phone/Fax

Practice location:
  • Phone: 718-938-3777
  • Fax:
Mailing address:
  • Phone: 718-938-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007904-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: