Provider Demographics
NPI:1275573990
Name:LEE, ALICE K (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:K
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 527823
Mailing Address - Street 2:FLUSHING
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-7823
Mailing Address - Country:US
Mailing Address - Phone:718-321-2122
Mailing Address - Fax:718-321-0148
Practice Address - Street 1:13630 MAPLE AVE STE 1F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3866
Practice Address - Country:US
Practice Address - Phone:718-321-2122
Practice Address - Fax:718-321-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163807207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01216811Medicaid
NY05535Medicare ID - Type Unspecified
NYE70920Medicare UPIN