Provider Demographics
NPI:1437398401
Name:LEE, MONA (LAC)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:LEE
Other - Last Name:YUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2954 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1944
Mailing Address - Country:US
Mailing Address - Phone:516-766-0897
Mailing Address - Fax:516-766-0318
Practice Address - Street 1:2954 CLARK AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1944
Practice Address - Country:US
Practice Address - Phone:516-766-0897
Practice Address - Fax:516-766-0318
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003490-1171100000X
NY008317-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist