Basic Information
| Provider Information | |||||||||
| NPI: | 1417164492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009423376 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | PORT CHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105734943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149345800 | ||||||||
| FaxNumber: | 9149349819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 256888 | NY | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0900X | 256888 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207N00000X | A111736 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0900X | A111736 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
No ID Information.