Provider Demographics
NPI:1235125956
Name:LEE, MOON H (MD)
Entity Type:Individual
Prefix:DR
First Name:MOON
Middle Name:H
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 1:41 DAVIS AVE
Mailing Address - Street 2:PATHOLOGY DEPARTMENT WPH
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1034
Mailing Address - Country:US
Mailing Address - Phone:914-681-1243
Mailing Address - Fax:
Practice Address - Street 1:41 DAVIS AVE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1034
Practice Address - Country:US
Practice Address - Phone:914-681-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127015207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF21330Medicare UPIN
NY15G771Medicare ID - Type Unspecified