Provider Demographics
NPI:1073895082
Name:LEE, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 57TH ST
Mailing Address - Street 2:STE. 829
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10107-0001
Mailing Address - Country:US
Mailing Address - Phone:646-271-6008
Mailing Address - Fax:
Practice Address - Street 1:250 W 57TH ST
Practice Address - Street 2:STE. 829
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107-0001
Practice Address - Country:US
Practice Address - Phone:646-271-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1733171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist