Healthcare Provider Details

I. General information

NPI: 1942610282
Provider Name (Legal Business Name): ADA LEE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK CHILDREN'S HOSPITAL DEPARTMENT OF PEDIATRICS, HSC T-11, ROOM 080
STONY BROOK NY
11794-8111
US

IV. Provider business mailing address

101 NICOLLS RD HSC T11-080
STONY BROOK NY
11794
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8115
  • Fax: 631-444-6045
Mailing address:
  • Phone: 631-444-8115
  • Fax: 631-444-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number288914
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number288914
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: