Provider Demographics
NPI:1144394966
Name:LEE, EDWARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164-10 NORTHERN BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-321-8333
Mailing Address - Fax:718-321-1106
Practice Address - Street 1:164-10 NORTHERN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-321-8333
Practice Address - Fax:718-321-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215485207RN0300X, 207R00000X, 207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02355017Medicaid
NYH53346Medicare UPIN
NYG400068321Medicare PIN
NY04908AMedicare Oscar/Certification