Healthcare Provider Details

I. General information

NPI: 1851487243
Provider Name (Legal Business Name): LINDA Y LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD SUITE 106
GREAT NECK NY
11021-5206
US

IV. Provider business mailing address

600 NORTHERN BLVD SUITE 106
GREAT NECK NY
11021-5206
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-4128
  • Fax: 516-482-1822
Mailing address:
  • Phone: 516-466-4128
  • Fax: 516-482-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number205613-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: