Provider Demographics
NPI:1326177734
Name:LEE, DANIELLE (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BAY CLUB DR
Mailing Address - Street 2:APT 7W
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2917
Mailing Address - Country:US
Mailing Address - Phone:646-808-6170
Mailing Address - Fax:347-836-8296
Practice Address - Street 1:17 THROCKMORTON LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2548
Practice Address - Country:US
Practice Address - Phone:732-679-1666
Practice Address - Fax:732-679-5599
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002796171100000X
NJ25MZ00045700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist