Provider Demographics
NPI:1154355253
Name:LEE, WAH SANG (DO)
Entity type:Individual
Prefix:
First Name:WAH
Middle Name:SANG
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BAY 31ST ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4110
Mailing Address - Country:US
Mailing Address - Phone:917-204-8780
Mailing Address - Fax:
Practice Address - Street 1:17 ELIZABETH ST
Practice Address - Street 2:SUITE 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-966-8889
Practice Address - Fax:212-966-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231035204D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02729124Medicaid
NYI41453Medicare UPIN
NY1551J1Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY02729124Medicaid