Provider Demographics
NPI:1417957523
Name:LEE, CHUCK WING (NP)
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:WING
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 1:395 BROADWAY
Mailing Address - Street 2:#100
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3539
Mailing Address - Country:US
Mailing Address - Phone:212-966-1478
Mailing Address - Fax:
Practice Address - Street 1:395 BROADWAY
Practice Address - Street 2:#100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3539
Practice Address - Country:US
Practice Address - Phone:212-966-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300265363LA2200X
NYF330581363LF0000X
NYF360048363LP0200X
NYF380329363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology