Active NPI
Jungeun Jay Lee, MD
- Anatomic Pathology & Clinical Pathology Physician
- Gloversville, NY
National Provider Identifier
1659362671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 108212
- Practice address
- 99 E State St
Gloversville, NY 12078-1203 - Phone
- (518) 389-1725
- NPI assigned
- Oct 31, 2005
- Last updated
- Apr 13, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 108212 | NY | Primary |
Addresses
Primary practice location
99 E State St
Gloversville, NY 12078-1203
Mailing address
PO Box 363
Latham, NY 12110-0363
Phone (518) 389-1803
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01121535 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108212 | NY | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586736000000",
"number": "1659362671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 363",
"city": "LATHAM",
"state": "NY",
"postal_code": "121100363",
"telephone_number": "518-389-1803",
"fax_number": "518-389-1788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 E STATE ST",
"city": "GLOVERSVILLE",
"state": "NY",
"postal_code": "120781203",
"telephone_number": "518-389-1725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JUNGEUN",
"middle_name": "JAY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2020-04-13",
"certification_date": "2020-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NY",
"license": "108212",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01121535",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gloversville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.