Provider Demographics
NPI:1659766558
Name:LEE, MINWHA
Entity Type:Individual
Prefix:
First Name:MINWHA
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 1:565 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3424
Mailing Address - Country:US
Mailing Address - Phone:212-470-1000
Mailing Address - Fax:800-604-6146
Practice Address - Street 1:565 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3424
Practice Address - Country:US
Practice Address - Phone:212-470-1000
Practice Address - Fax:800-604-6146
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693199163W00000X
NJ26NR17877600163W00000X
NYF307595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse