Brian Lee

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Woodside, NY

NPI 1174065429 · NPPES record last updated Nov 16, 2016

Key facts

NPI
1174065429
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
6210 Woodside Ave Apt 211
Woodside, NY 11377-3681
Phone
(347) 307-5423
NPI assigned
Nov 16, 2016
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

6210 Woodside Ave Apt 211
Woodside, NY 11377-3681

Mailing address

6210 Woodside Ave Apt 211
Woodside, NY 11377-3681

Other providers in Woodside, NY

All providers in Woodside, NY · Student in an Organized Health Care Education/Training Program in New York

Sources for this page

Verify at the official NPI Registry.