Basic Information
Provider Information
NPI: 1245529627
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: AILEEN
MiddleName: LENG
NamePrefix: MS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 55 WATER STREET
Address2: 2ND FLOOR CRED DEPT
City: NEW YORK
State: NY
PostalCode: 100415204
CountryCode: US
TelephoneNumber: 6466802888
FaxNumber: 5165425556
Practice Location
Address1: 21 EAST 22ND STREET
Address2:  
City: NEW YORK
State: NY
PostalCode: 100105332
CountryCode: US
TelephoneNumber: 2124607800
FaxNumber: 2124607877
Other Information
ProviderEnumerationDate: 04/06/2011
LastUpdateDate: 09/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XF336585NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363L00000XF336585NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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