Individual
JAE EUN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
444 WILLIS AVE, BRONX, NY 10455-4013
(347) 862-2700
Mailing address
444 WILLIS AVE, BRONX, NY 10455-4013
(347) 862-2700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
620172
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F309262-01
NY
Other
Enumeration date
06/16/2010
Last updated
03/02/2021
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