Healthcare Provider Details

I. General information

NPI: 1023070075
Provider Name (Legal Business Name): MYUNG-HO LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 RYE RIDGE PLZ
RYE BROOK NY
10573-2820
US

IV. Provider business mailing address

PO BOX 628
PURCHASE NY
10577-0628
US

V. Phone/Fax

Practice location:
  • Phone: 914-593-7872
  • Fax: 914-593-7881
Mailing address:
  • Phone: 914-593-7872
  • Fax: 914-593-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number182644
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number182644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: