Provider Demographics
NPI:1841462413
Name:MARK DAH JEN LEE SURGERY PC
Entity type:Organization
Organization Name:MARK DAH JEN LEE SURGERY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAH JEN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-343-0379
Mailing Address - Street 1:185 CANAL ST FRNT 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4537
Mailing Address - Country:US
Mailing Address - Phone:212-343-0379
Mailing Address - Fax:212-343-0393
Practice Address - Street 1:86 BOWERY # 5F
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182896208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
051227300808OtherFIDELIS
NY051227300808OtherCENTERCARE
NY1700749OtherUNITED HALTHCARE
NY01253832Medicaid
NY051227300808OtherFIDELIS
1010813OtherUNITED HEALTHCAER
NY182896OtherHIP
NY182896B31OtherHEALTHFIRST
CA5C6359OtherHEALTH NET OF NORTHEAST
NY010182896NY03OtherANTHEM
NY335200101OtherHEALTHPLUS
NY182896-01OtherNEIGHBORHOOD
2801H1OtherEMPIRE BLUE CROSS AND BLUE SHIELD
182896OtherHIP
NY2700066OtherAETNA
NY0100572OtherGHI
NY051227300808OtherCENTER CARE
NY119862OtherWELLCARE
NY2801H1OtherBLUE CROSS AND BLUE SHIEL
NYKS531OtherOXFORD
NY2801H1OtherBLUE CROSS AND BLUE SHIEL