Provider Demographics
NPI:1699003921
Name:LEE, SHIN JI (MD)
Entity Type:Individual
Prefix:
First Name:SHIN
Middle Name:JI
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 1:866 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2905
Mailing Address - Country:US
Mailing Address - Phone:516-280-8202
Mailing Address - Fax:516-280-8204
Practice Address - Street 1:866 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2905
Practice Address - Country:US
Practice Address - Phone:516-280-8202
Practice Address - Fax:516-280-8204
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191864-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY191864-1OtherLICENCE NUMBER