Provider Demographics
NPI:1174680151
Name:CHRISTOPHER LEE MEDICAL P.C.,
Entity Type:Organization
Organization Name:CHRISTOPHER LEE MEDICAL P.C.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-872-9515
Mailing Address - Street 1:14 CLARENDON PL
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2418
Mailing Address - Country:US
Mailing Address - Phone:646-872-9515
Mailing Address - Fax:
Practice Address - Street 1:14 CLARENDON PL
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-2418
Practice Address - Country:US
Practice Address - Phone:646-872-9515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-11-25
Deactivation Date:2008-08-04
Deactivation Code:
Reactivation Date:2009-09-16
Provider Licenses
StateLicense IDTaxonomies
NY227375207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02644806Medicaid
NYI21943Medicare UPIN
NY02644806Medicaid