Provider Demographics
NPI:1114991882
Name:LEE, EUNA (MD)
Entity Type:Individual
Prefix:
First Name:EUNA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133-47 SANFORD AVE.
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-539-5555
Mailing Address - Fax:718-539-9113
Practice Address - Street 1:133-47 SANFORD AVE.
Practice Address - Street 2:SUITE 1E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-539-5555
Practice Address - Fax:718-539-9113
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217518207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02277443Medicaid
NYH58212Medicare UPIN
NY5F3961Medicare PIN
NY5F3961Medicare ID - Type Unspecified
NY02277443Medicaid