MEDICARE: JONGMI LEE NP IN ADULT & FAMILY HEALTH PLLC

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	363LA2200X	Adult Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1972071660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONGMI LEE NP IN ADULT & FAMILY HEALTH PLLC

Provider Business Mailing Address
First Line	:	2623 SEDGWICK AVE
Second Line	:	4D
City	:	BRONX
State	:	NY
Zip	:	10468-3839
Country	:	US
Telephone Number	:	929-352-0454
Fax Number	:	929-352-0455

Provider Business Practice Location Address
First Line	:	2623 SEDGWICK AVE
Second Line	:	4D
City	:	BRONX
State	:	NY
Zip	:	10468-3839
Country	:	US
Telephone Number	:	929-352-0454
Fax Number	:	929-352-0455

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	JONGMI LEE
Credential	:	NP-C, AGPCNP-BC
Telephone Number	:	929-352-0454

Provider Enumeration Date	:	11/11/2018
Last Update Date	:	12/20/2019

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