Provider Demographics
NPI:1801195839
Name:PEN FA LEE, M.D.,P.C.
Entity Type:Organization
Organization Name:PEN FA LEE, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEN
Authorized Official - Middle Name:FA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-968-6801
Mailing Address - Street 1:131 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2996
Mailing Address - Country:US
Mailing Address - Phone:914-968-6801
Mailing Address - Fax:914-968-3809
Practice Address - Street 1:131 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2996
Practice Address - Country:US
Practice Address - Phone:914-968-6801
Practice Address - Fax:914-968-3809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEN FA LEE, M.D.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY580791Medicare PIN
NYB78131Medicare UPIN