Provider Demographics
NPI:1538512850
Name:LEE, HAE
Entity Type:Individual
Prefix:
First Name:HAE
Middle Name:
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 1:577 GRAND STREET
Mailing Address - Street 2:F804
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6612
Mailing Address - Country:US
Mailing Address - Phone:917-428-0094
Mailing Address - Fax:
Practice Address - Street 1:577 GRAND STREET
Practice Address - Street 2:F804
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6612
Practice Address - Country:US
Practice Address - Phone:917-428-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12286308-1204208D00000X
NY299297208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty