Provider Demographics
NPI:1487690772
Name:LEE, JOONSEO (PT)
Entity type:Individual
Prefix:
First Name:JOONSEO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 7TH AVE STE 1210
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2024
Mailing Address - Country:US
Mailing Address - Phone:646-476-7950
Mailing Address - Fax:646-479-7935
Practice Address - Street 1:9 E 45TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2425
Practice Address - Country:US
Practice Address - Phone:646-476-7950
Practice Address - Fax:646-479-7935
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002464171100000X
NY015671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015617OtherHIP
NYQ11Q51OtherEMPIRE BCBS
NY02298011Medicaid
NY6606159OtherGHI PPO
NY7749253OtherAETNA
NYP3304320OtherOXFORD
NYN89704OtherHEALTHNET
NYP00000061357OtherGHI HMO
NYQP8721Medicare ID - Type Unspecified