Provider Demographics
NPI:1003818477
Name:LEE, ALLEN L (MD DIPLOMATEABFP)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:MD DIPLOMATEABFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1604
Mailing Address - Country:US
Mailing Address - Phone:718-748-1320
Mailing Address - Fax:718-921-0341
Practice Address - Street 1:433 72ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1604
Practice Address - Country:US
Practice Address - Phone:718-748-1320
Practice Address - Fax:718-321-0341
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1126622OtherOXFORD
NY521682OtherAETNA US HEALTHCARE
NY5726D1OtherEMPIREBLUECROSSBLUESHIELD
NY0022001OtherGHI
NYP1126622OtherOXFORD
NY12A751Medicare PIN