Provider Demographics
NPI:1255491734
Name:LEE, NORMAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:N
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 1:8310 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4245
Mailing Address - Country:US
Mailing Address - Phone:718-507-0445
Mailing Address - Fax:718-651-2262
Practice Address - Street 1:8310 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4245
Practice Address - Country:US
Practice Address - Phone:718-507-0445
Practice Address - Fax:718-651-2262
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01408593Medicaid
NYE48942Medicare UPIN
NY00306Medicare ID - Type Unspecified