Healthcare Provider Details

I. General information

NPI: 1225316847
Provider Name (Legal Business Name): SUSAN C LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2011
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST DEPARTMENT OF RADIOLOGY AND IMAGING
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

1161 YORK AVE APT 11M
NEW YORK NY
10065-7940
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1936
  • Fax:
Mailing address:
  • Phone: 908-227-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0000000000
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number282850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: