Provider Demographics
NPI:1972071660
Name:JONGMI LEE NP IN ADULT & FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:JONGMI LEE NP IN ADULT & FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:JONGMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C, AGPCNP-BC
Authorized Official - Phone:929-352-0454
Mailing Address - Street 1:2623 SEDGWICK AVE
Mailing Address - Street 2:4D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3839
Mailing Address - Country:US
Mailing Address - Phone:929-352-0454
Mailing Address - Fax:929-352-0455
Practice Address - Street 1:2623 SEDGWICK AVE
Practice Address - Street 2:4D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3839
Practice Address - Country:US
Practice Address - Phone:929-352-0454
Practice Address - Fax:929-352-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-11
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03274751Medicaid
NY03274751Medicaid