MEDICARE: EUNYOUNG LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	032405	NY

General Provider Information

NPI Number	:	1013450832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNYOUNG LEE

Provider Business Mailing Address
First Line	:	4346 165TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3227
Country	:	US
Telephone Number	:	718-414-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 3RD AVE
Second Line	:	4TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10455-4066
Country	:	US
Telephone Number	:	718-401-3000
Fax Number	:	718-292-8610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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