Provider Demographics
NPI:1205932654
Name:LEE, DAHJEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAHJEN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:191 MELHORN RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5555
Mailing Address - Country:US
Mailing Address - Phone:718-698-0555
Mailing Address - Fax:
Practice Address - Street 1:86 BOWERY FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4615
Practice Address - Country:US
Practice Address - Phone:212-343-0379
Practice Address - Fax:212-343-0393
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182896208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01253832Medicaid
NYF24918Medicare UPIN
NYWES581Medicare ID - Type Unspecified