Provider Demographics
NPI:1558500611
Name:LEE, ANITA CHER-JEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CHER-JEN
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:CHER-JEN
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:86 BOWERY
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4615
Mailing Address - Country:US
Mailing Address - Phone:212-219-2883
Mailing Address - Fax:212-219-2705
Practice Address - Street 1:2079 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1735
Practice Address - Country:US
Practice Address - Phone:718-815-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012885363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical