Provider Demographics
NPI:1841426780
Name:LEE, SUNG HO (MD)
Entity type:Individual
Prefix:
First Name:SUNG HO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1912
Mailing Address - Country:US
Mailing Address - Phone:845-480-7440
Mailing Address - Fax:845-480-7448
Practice Address - Street 1:160 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1912
Practice Address - Country:US
Practice Address - Phone:845-480-7440
Practice Address - Fax:845-480-7448
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270831207RH0003X, 261QM2500X, 282N00000X, 261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03628140Medicaid
A400089256Medicare PIN