Provider Demographics
NPI:1679809206
Name:LEE, EDWARD (LAC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:EDD
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:89 5TH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3020
Mailing Address - Country:US
Mailing Address - Phone:347-948-3533
Mailing Address - Fax:929-235-7581
Practice Address - Street 1:89 5TH AVE STE 305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3020
Practice Address - Country:US
Practice Address - Phone:347-948-3533
Practice Address - Fax:929-235-7581
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023437225700000X
NY005108171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist