Basic Information
| Provider Information | |||||||||
| NPI: | 1124597869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | HO | ||||||||
| MiddleName: | JU-PITER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 FREEDOM AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103143704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188871145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 214 W HOUSTON ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100144846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123379400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2018 | ||||||||
| LastUpdateDate: | 11/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 011803 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.