Provider Demographics
NPI:1356968366
Name:LEE, HOWARD HOSANG (LAC, DOM)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:HOSANG
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVER STREET EXT APT 312
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1133
Mailing Address - Country:US
Mailing Address - Phone:516-315-5508
Mailing Address - Fax:
Practice Address - Street 1:290 MADISON AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6306
Practice Address - Country:US
Practice Address - Phone:347-954-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000784171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty