Provider Demographics
NPI:1407814080
Name:LEE, CHAU H (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAU
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 LARKFIELD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4205
Mailing Address - Country:US
Mailing Address - Phone:631-368-3800
Mailing Address - Fax:631-368-3802
Practice Address - Street 1:554 LARKFIELD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4205
Practice Address - Country:US
Practice Address - Phone:631-368-3800
Practice Address - Fax:631-368-3802
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041791174400000X
NY251958-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H96458Medicare UPIN