Healthcare Provider Details

I. General information

NPI: 1629033501
Provider Name (Legal Business Name): JANE A LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

PO BOX 52788
KNOXVILLE TN
37950-2788
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2685
  • Fax: 212-434-2253
Mailing address:
  • Phone: 865-588-2928
  • Fax: 865-450-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number221921-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: