Provider Demographics
NPI:1023465424
Name:LEE, STEPHANIE K (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GRAND ST STE 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4396
Mailing Address - Country:US
Mailing Address - Phone:212-966-3585
Mailing Address - Fax:212-966-5530
Practice Address - Street 1:859 60TH ST # CM1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4352
Practice Address - Country:US
Practice Address - Phone:718-854-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298270208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics