Provider Demographics
NPI:1922072115
Name:LEE, SUSANNE Y (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:Y
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 1:7 EVERGREEN ROW
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2208
Mailing Address - Country:US
Mailing Address - Phone:914-273-3248
Mailing Address - Fax:
Practice Address - Street 1:700 WHITE PLAINS RD
Practice Address - Street 2:SUITE 22
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5063
Practice Address - Country:US
Practice Address - Phone:914-472-2080
Practice Address - Fax:914-472-0274
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01217963Medicaid
NY94F931Medicare ID - Type Unspecified
NY01217963Medicaid