Provider Demographics
NPI:1801902754
Name:LEE, RANG JU Y (FNP)
Entity type:Individual
Prefix:MR
First Name:RANG JU
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34-20 PARSONS BLVD
Mailing Address - Street 2:SUITE LR/LS
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-460-4191
Mailing Address - Fax:718-353-4645
Practice Address - Street 1:34-20 PARSONS BLVD
Practice Address - Street 2:SUITE LR/LS
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-460-4191
Practice Address - Fax:718-353-4645
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily