Provider Demographics
NPI:1427012731
Name:BIDOL-LEE, SOHEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SOHEE
Middle Name:
Last Name:BIDOL-LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:SOHEE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 WEST CENTURY ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1440
Mailing Address - Country:US
Mailing Address - Phone:201-632-5057
Mailing Address - Fax:201-227-6207
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:ATTN: HEALTH PARTNER SERVICES
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3000
Practice Address - Fax:201-483-9201
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232147207RN0300X
NJ25MA09597800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02552761Medicaid
NY02552761Medicaid
013SG1Medicare ID - Type Unspecified