Provider Demographics
NPI:1265479331
Name:LEE, WAY F (MD, PC)
Entity Type:Individual
Prefix:
First Name:WAY
Middle Name:F
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:786 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4926
Mailing Address - Country:US
Mailing Address - Phone:631-669-3700
Mailing Address - Fax:631-669-0222
Practice Address - Street 1:786 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4926
Practice Address - Country:US
Practice Address - Phone:631-669-3700
Practice Address - Fax:631-669-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2013-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY239069208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY239069OtherLICENSE
NYI52559Medicare UPIN