Provider Demographics
NPI:1932661345
Name:LEE, MABEL (RD, CDN, CDCES)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RD, CDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 108TH ST APT 507
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4360
Mailing Address - Country:US
Mailing Address - Phone:646-593-4965
Mailing Address - Fax:
Practice Address - Street 1:560 NORTHERN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5113
Practice Address - Country:US
Practice Address - Phone:516-482-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered