Healthcare Provider Details

I. General information

NPI: 1740607068
Provider Name (Legal Business Name): HYUNJOO LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK UNIVERSITY HOSPITAL HSC L-4, ROOM 080
STONY BROOK NY
11794
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2478
  • Fax: 631-444-3919
Mailing address:
  • Phone: 631-444-2478
  • Fax: 631-444-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number286832
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: