Provider Demographics
NPI:1629033501
Name:LEE, JANE A (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 52788
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2788
Mailing Address - Country:US
Mailing Address - Phone:865-588-2928
Mailing Address - Fax:865-450-9374
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2685
Practice Address - Fax:212-434-2253
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221921-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02423967Medicaid
NYP00267955OtherRR MCARE
NJ0075914Medicaid
NY758T61OtherEMPIRE BCBS
NY02423967Medicaid
NYH99865Medicare UPIN
NY664T9TG231Medicare PIN
NY758T61OtherEMPIRE BCBS
NYP00267955OtherRR MCARE
NY02423967Medicaid