Provider Demographics
NPI:1114004629
Name:LEE, GENEVIEVE (LAC)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 JERICHO TURNPIKE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-742-0637
Mailing Address - Fax:516-742-0318
Practice Address - Street 1:393 JERICHO TURNPIKE
Practice Address - Street 2:SUITE 207
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-742-0637
Practice Address - Fax:516-742-0318
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0017391171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2625664OtherOXFORD
NY6685KOtherBCBS