Provider Demographics
NPI:1124369509
Name:LEE, CHRISTINE G (ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:G
Last Name:LEE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:G
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:330 E 65TH ST
Mailing Address - Street 2:APT 19
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6750
Mailing Address - Country:US
Mailing Address - Phone:508-561-0835
Mailing Address - Fax:
Practice Address - Street 1:330 E 65TH ST
Practice Address - Street 2:APT 19
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6750
Practice Address - Country:US
Practice Address - Phone:508-561-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist