Provider Demographics
NPI:1952921645
Name:LEE, CHRISTINE JISUN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:JISUN
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 METROPOLITAN AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3041
Mailing Address - Country:US
Mailing Address - Phone:917-731-8232
Mailing Address - Fax:
Practice Address - Street 1:75-59 263RD STREET
Practice Address - Street 2:AMBULATORY CARE PAVILION, ROOM 1248
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1100
Practice Address - Country:US
Practice Address - Phone:718-470-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023574103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist