Provider Demographics
NPI:1275274870
Name:LEE, MARCUS
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEALTH SCIENCE CENTER T16
Mailing Address - Street 2:ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-444-7411
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:HEALTH SCIENCE CENTER T16
Practice Address - Street 2:ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-8160
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program