Provider Demographics
NPI:1154879401
Name:LEE, JOHN DONGYEOP (PHD, LAC, OTR/L)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONGYEOP
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD, LAC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E 36TH ST STE 901
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3368
Mailing Address - Country:US
Mailing Address - Phone:646-363-1707
Mailing Address - Fax:
Practice Address - Street 1:11 E 36TH ST STE 901
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3368
Practice Address - Country:US
Practice Address - Phone:646-363-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003740171100000X
NY020622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171100000XOther Service ProvidersAcupuncturist