Provider Demographics
NPI:1144379942
Name:LEE, ESTHER PARK
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:PARK
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 1:200 N HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3608
Mailing Address - Country:US
Mailing Address - Phone:718-383-2079
Mailing Address - Fax:
Practice Address - Street 1:3170 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3341
Practice Address - Country:US
Practice Address - Phone:212-678-8423
Practice Address - Fax:212-678-8461
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist