Provider Demographics
NPI:1629334198
Name:LEE, NICOLE YAR-LUTE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:YAR-LUTE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FRANKLIN AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5815
Mailing Address - Country:US
Mailing Address - Phone:516-506-0800
Mailing Address - Fax:516-506-0802
Practice Address - Street 1:520 FRANKLIN AVE STE 211
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5815
Practice Address - Country:US
Practice Address - Phone:516-506-0800
Practice Address - Fax:516-506-0802
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289445207N00000X
MA265477207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty