Basic Information
| Provider Information | |||||||||
| NPI: | 1871547752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 W 165TH ST | ||||||||
| Address2: | BOX 92 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 635 W 165TH ST | ||||||||
| Address2: | FLANZER SUITE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059535 | ||||||||
| FaxNumber: | 2123425293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 238714 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.