Individual provider Active NPI

Jennifer S Lee, DMD

  • Dentist
  • New York, NY
National Provider Identifier
1407978836
Registry record updated Dec 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
050805 Issued in NY
Practice address
110 W 97TH St
New York, NY 10025-6450
Phone
(212) 749-1820
Fax
(212) 531-4063
NPI assigned
Apr 5, 2007
Last updated
Dec 5, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 050805 NY Primary

Addresses

Primary practice location

110 W 97TH St
New York, NY 10025-6450

Mailing address

110 W 97TH St
New York, NY 10025-6450
Phone (212) 749-1820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150708000916 NY Practitioner - Oral Surgery 0648582437 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Rutgers School of Dental Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 W 97 St
New York, NY 10025-6450
Phone (212) 531-7533

801 Amsterdam Ave
New York, NY 10025-5752
Phone (212) 531-7533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
050805NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
William F Ryan Community Health Center Inc CurrentSince Sep 5, 2006 Accepting new patients
William F Ryan Community Health Center Inc CurrentSince Sep 5, 2006 Accepting new patients
Ryan-Chelsea Clinton Community Health Center Past Accepting new patients

Locations

110 W 97th St
New York, NY 10025
Phone (212) 316-7906

110 W 97th St
#0
New York, NY 10025

Interoperability endpoints

  • Direct secure messaging: jennifer.lee@wfrchc.eclinicaldirectplus.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354665600000",
    "number": "1407978836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W 97TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256450",
            "telephone_number": "212-749-1820",
            "fax_number": "212-531-4063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W 97TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256450",
            "telephone_number": "212-749-1820",
            "fax_number": "212-531-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JENNIFER",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-05",
        "last_updated": "2012-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "050805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.