Provider Demographics
NPI:1043397680
Name:LEE, JOHN (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:5836 FIELDSTON RD
Mailing Address - Street 2:PRIVATE HOUSE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2212
Mailing Address - Country:US
Mailing Address - Phone:718-601-3192
Mailing Address - Fax:
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:PSYCHIATRY - MMTP
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-503-7794
Practice Address - Fax:718-503-7751
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY363AMO700X363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical