Provider Demographics
NPI:1104950047
Name:LEE, MARY ANN KAY WING (MD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:KAY WING
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2167
Mailing Address - Country:US
Mailing Address - Phone:718-210-1030
Mailing Address - Fax:718-871-0969
Practice Address - Street 1:5008 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2167
Practice Address - Country:US
Practice Address - Phone:718-210-1030
Practice Address - Fax:718-871-0969
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1359892080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01164218Medicaid