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NPI Code Detail

MEDICARE: CAROLYN LEE MOK M.D.

MEDICARE: CAROLYN LEE MOK M.D.
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
1207Q00000XFamily Medicine Physician135739NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5080130761OTHERNYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1102305BFOTHERNYPREFERRED CARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3P010135739OTHERNYBLUE CHOICE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
66906OTHERNYBLUE CROSS OF ROCHESTER

General Provider Information

NPI Number : 1578582219
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN LEE MOK M.D.
Provider Business Mailing Address
First Line : 322 LAKE AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14608-1017
Country : US
Telephone Number : 585-254-6480
Fax Number : 585-254-1092
Provider Business Practice Location Address
First Line : 322 LAKE AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14608-1017
Country : US
Telephone Number : 585-254-6480
Fax Number : 585-254-1092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/09/2007

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Directions to “ CAROLYN LEE MOK M.D.” Practice Location

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