Provider Demographics
NPI:1710078993
Name:LEE, COLLEEN INSOOK (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:INSOOK
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INSOOK
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3825 PARSONS BLVD
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5839
Mailing Address - Country:US
Mailing Address - Phone:718-353-4100
Mailing Address - Fax:718-939-5500
Practice Address - Street 1:1270 BROADWAY
Practice Address - Street 2:STE #405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3211
Practice Address - Country:US
Practice Address - Phone:212-714-1170
Practice Address - Fax:212-290-9061
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01726547Medicaid
NYF78771Medicare UPIN
NYF78771Medicare UPIN