Provider Demographics
NPI:1275717423
Name:LEE, JASON CHIONG (NP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHIONG
Last Name:LEE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 STATE ROUTE 208 STE 13
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4649
Mailing Address - Country:US
Mailing Address - Phone:845-783-6266
Mailing Address - Fax:845-783-9570
Practice Address - Street 1:1200 STATE ROUTE 208 STE 13
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4649
Practice Address - Country:US
Practice Address - Phone:845-783-6266
Practice Address - Fax:845-783-9570
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304606363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health