Healthcare Provider Details

I. General information

NPI: 1629225032
Provider Name (Legal Business Name): DR. ERIC LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 02/08/2020
Certification Date: 02/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E 57TH ST FL 2
NEW YORK NY
10022-2102
US

IV. Provider business mailing address

PO BOX 182255
COLUMBUS OH
43218-2255
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-2813
  • Fax: 646-607-9061
Mailing address:
  • Phone: 775-674-5632
  • Fax: 775-322-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD17795
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number264765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: