Provider Demographics
NPI:1750328894
Name:LEE, JIMMY YUEN HING (RPAC)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:YUEN HING
Last Name:LEE
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:MR
Other - First Name:JIMMY
Other - Middle Name:YUEN HING
Other - Last Name:LIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPAC
Mailing Address - Street 1:359 HENDRICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-825-6438
Mailing Address - Fax:
Practice Address - Street 1:25-10 30TH AVE
Practice Address - Street 2:MOUNT SINAI HOSPITAL OF QUEENS
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-2495
Practice Address - Country:US
Practice Address - Phone:631-267-4285
Practice Address - Fax:718-278-1766
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6504EQMedicare ID - Type Unspecified
Q11921Medicare UPIN