Provider Demographics
NPI:1538345863
Name:LEE, HEEOCK (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:HEEOCK
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 3RD AVE
Mailing Address - Street 2:APT 40C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3646
Mailing Address - Country:US
Mailing Address - Phone:646-228-1069
Mailing Address - Fax:
Practice Address - Street 1:57 W 57TH ST STE 602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:646-228-1069
Practice Address - Fax:212-308-2868
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302436363LA2200X
NY003596-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health