1841462413 NPI number — MARK DAH JEN LEE SURGERY PC

Table of content: (NPI 1841462413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841462413 NPI number — MARK DAH JEN LEE SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK DAH JEN LEE SURGERY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841462413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 CANAL ST FRNT 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10013-4537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-343-0379
Provider Business Mailing Address Fax Number:
212-343-0393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 BOWERY # 5F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-4615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-343-0379
Provider Business Practice Location Address Fax Number:
212-343-0393
Provider Enumeration Date:
03/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
DAH JEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-343-0379

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  182896 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051227300808 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051227300808 . This is a "CENTERCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1700749 . This is a "UNITED HALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01253832 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051227300808 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1010813 . This is a "UNITED HEALTHCAER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 182896 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 182896B31 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C6359 . This is a "HEALTH NET OF NORTHEAST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 010182896NY03 . This is a "ANTHEM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 335200101 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 182896-01 . This is a "NEIGHBORHOOD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2801H1 . This is a "EMPIRE BLUE CROSS AND BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 182896 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2700066 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0100572 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 051227300808 . This is a "CENTER CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 119862 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2801H1 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: KS531 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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