Provider Demographics
NPI:1841564465
Name:LEE, JACKIE M (AADP)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:AADP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W 75TH ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2024
Mailing Address - Country:US
Mailing Address - Phone:917-202-2647
Mailing Address - Fax:
Practice Address - Street 1:50 W 75TH ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2024
Practice Address - Country:US
Practice Address - Phone:917-202-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education