Provider Demographics
NPI:1407195001
Name:LEE, MAN KI MAGGIE
Entity Type:Individual
Prefix:
First Name:MAN KI
Middle Name:MAGGIE
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 1:13828 68TH DR
Mailing Address - Street 2:APT 1D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13828 68TH DR
Practice Address - Street 2:APT 1D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1669
Practice Address - Country:US
Practice Address - Phone:646-593-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017574225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist