Basic Information
| Provider Information | |||||||||
| NPI: | 1629033501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52788 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379502788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655882928 | ||||||||
| FaxNumber: | 8654509374 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E 77TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100751850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124342685 | ||||||||
| FaxNumber: | 2124342253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 221921-1 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02423967 | 05 | NY | MEDICAID | P00267955 | 01 | NY | RR MCARE | OTHER | 0075914 | 05 | NJ | MEDICAID | 758T61 | 01 | NY | EMPIRE BCBS | OTHER |