Provider Demographics
NPI:1720030042
Name:LEE, SUSAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
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 1:9525 QUEENS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4511
Mailing Address - Country:US
Mailing Address - Phone:718-975-5200
Mailing Address - Fax:
Practice Address - Street 1:9525 QUEENS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4511
Practice Address - Country:US
Practice Address - Phone:718-975-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229649207V00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02523095Medicaid
NY02523095Medicaid
NY06249Medicare ID - Type Unspecified