Provider Demographics
NPI:1225094006
Name:LEE, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:268 CANAL STREET CHARLES B WANG COMMUNITY HEALTH CENTER
Mailing Address - Street 2:6 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-379-5307
Mailing Address - Fax:212-379-6936
Practice Address - Street 1:268 CANAL ST
Practice Address - Street 2:6 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3599
Practice Address - Country:US
Practice Address - Phone:212-379-5307
Practice Address - Fax:212-379-6936
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY127642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC12059Medicare UPIN
73A971Medicare ID - Type Unspecified