Healthcare Provider Details

I. General information

NPI: 1033457783
Provider Name (Legal Business Name): COLLEEN COURNOT DDS & JENNY M. LEE DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 40TH ST SUITE 900
NEW YORK NY
10016-1201
US

IV. Provider business mailing address

30 E 40TH ST SUITE 900
NEW YORK NY
10016-1201
US

V. Phone/Fax

Practice location:
  • Phone: 212-682-0770
  • Fax: 212-682-5310
Mailing address:
  • Phone: 212-682-0770
  • Fax: 212-682-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050640
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNY M LEE
Title or Position: OWNER
Credential: DDS
Phone: 212-682-0770