Provider Demographics
NPI:1417984097
Name:LEE, JAY YUNG (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:YUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 BROADWAY
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:NEW
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-590-2930
Mailing Address - Fax:212-590-2982
Practice Address - Street 1:1000 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-590-2930
Practice Address - Fax:212-590-2982
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1407652085R0202X
NY1751982085R0205X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02001307Medicaid
OH0421870Medicaid
NY695781Medicare ID - Type Unspecified