Individual
JUNGEUN JAY LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
99 E STATE ST, GLOVERSVILLE, NY 12078-1203
(518) 389-1725
Mailing address
PO BOX 363, LATHAM, NY 12110-0363
(518) 389-1803
(518) 389-1788
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
108212
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01121535
—
NY
Enumeration date
10/31/2005
Last updated
04/13/2020
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