Provider Demographics
NPI:1538555743
Name:LEE, EUNMYUNG (NP)
Entity type:Individual
Prefix:
First Name:EUNMYUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 PARSONS BLVD
Mailing Address - Street 2:STE 1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5841
Mailing Address - Country:US
Mailing Address - Phone:718-762-3240
Mailing Address - Fax:718-732-3039
Practice Address - Street 1:3825 PARSONS BLVD STE 1G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5839
Practice Address - Country:US
Practice Address - Phone:718-353-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339210363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY339210OtherLICENSE