Provider Demographics
NPI:1558730747
Name:LEE, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W NICHOLAI ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3876
Mailing Address - Country:US
Mailing Address - Phone:516-822-6722
Mailing Address - Fax:516-822-6717
Practice Address - Street 1:21 W NICHOLAI ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3876
Practice Address - Country:US
Practice Address - Phone:516-822-6722
Practice Address - Fax:516-822-6717
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0331171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist