MEDICARE: JANELLE LEE LPN

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	164W00000X	Licensed Practical Nurse	338104	NY

General Provider Information

NPI Number	:	1780332569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE LEE LPN

Provider Business Mailing Address
First Line	:	405 DUMONT AVE APT 3S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-7379
Country	:	US
Telephone Number	:	347-280-4739
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 W 106TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-3714
Country	:	US
Telephone Number	:	718-206-2000
Fax Number	:

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

Provider Enumeration Date	:	03/11/2022
Last Update Date	:	03/11/2022

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Directions to “ JANELLE LEE LPN” Practice Location

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