Provider Demographics
NPI:1861816605
Name:LEE, MEERAN KIM (RN, MSN, ANP/GNP-BC)
Entity Type:Individual
Prefix:
First Name:MEERAN
Middle Name:KIM
Last Name:LEE
Suffix:
Gender:F
Credentials:RN, MSN, ANP/GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-3273
Mailing Address - Fax:212-305-6692
Practice Address - Street 1:622 W 168TH ST PH 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-3273
Practice Address - Fax:212-305-6692
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340921-1363LG0600X
NYF306588-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology