Provider Demographics
NPI:1811057516
Name:LEE, SEUNG HO (MD)
Entity type:Individual
Prefix:DR
First Name:SEUNG HO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12733-0116
Mailing Address - Country:US
Mailing Address - Phone:845-434-2080
Mailing Address - Fax:845-434-0918
Practice Address - Street 1:325 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12733-5308
Practice Address - Country:US
Practice Address - Phone:845-434-2080
Practice Address - Fax:845-434-0918
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1268952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry