Provider Demographics
NPI:1295796266
Name:CHEON-LEE, ELAINE HEE-YOUNG (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:HEE-YOUNG
Last Name:CHEON-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:CARENET MEDICAL GROUP
Mailing Address - Street 2:2123 RIVER ROAD
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1135
Mailing Address - Country:US
Mailing Address - Phone:518-381-1121
Mailing Address - Fax:518-381-3930
Practice Address - Street 1:CARENET MEDICAL GROUP
Practice Address - Street 2:2123 RIVER ROAD
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-381-1121
Practice Address - Fax:518-381-3930
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203769207V00000X
HIMD-13495207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01752432Medicaid
NY51477XMedicare ID - Type Unspecified
NY01752432Medicaid