Provider Demographics
NPI:1932273596
Name:LEE, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
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 1519
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10276-1519
Mailing Address - Country:US
Mailing Address - Phone:929-428-2547
Mailing Address - Fax:651-666-1930
Practice Address - Street 1:122 E 42ND ST FL 17
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-1799
Practice Address - Country:US
Practice Address - Phone:929-428-2547
Practice Address - Fax:651-666-1930
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2325552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01854282Medicaid
NY331951Medicare Oscar/Certification
NY01854282Medicaid