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NPI Code Detail

MEDICARE: SU JUNG LEE

MEDICARE: SU JUNG 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
1363LF0000XFamily Nurse PractitionerF339256NY

General Provider Information

NPI Number : 1295201036
Entity Type Code : Individual
Provider Name (Legal Business Name) : SU JUNG LEE
Provider Business Mailing Address
First Line : 1468 MADISON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10029-6508
Country : US
Telephone Number : 212-241-6500
Fax Number :
Provider Business Practice Location Address
First Line : 1468 MADISON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10029-6508
Country : US
Telephone Number : 212-241-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2018
Last Update Date : 06/08/2026

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Directions to “ SU JUNG LEE ” Practice Location

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