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General NPI Number Information
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NPI Number | 1689646259
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Entity Type | Individual
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Provider Name | JAE SUNG LEE MD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 5300 MILITARY RD MOUNT ST MARYS HOSPITAL
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City | LEWISTON
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State | NY
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Zip | 14092
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Country | US
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Telephone | 716-297-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 5290 MILITARY RD STE 6
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City | LEWISTON
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State | NY
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Zip | 14092
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Country | US
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Telephone | 716-297-2998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 130958
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License Number State | NY
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