Provider Demographics
NPI:1538262464
Name:LEE, KWOK-MAN (MD)
Entity type:Individual
Prefix:
First Name:KWOK-MAN
Middle Name:
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 1:1180 CRESCENT WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6404
Mailing Address - Country:US
Mailing Address - Phone:212-732-3538
Mailing Address - Fax:212-732-3538
Practice Address - Street 1:198 CANAL ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4531
Practice Address - Country:US
Practice Address - Phone:212-732-3538
Practice Address - Fax:212-732-3538
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200351-A31OtherHEALTH FIRST
NY2C5560OtherPHS
519602OtherAETNA U.S. HEALTHCARE
NY2505315OtherGHI
NY200351OtherHIP
NY241941OtherBLUE CROSS/BLUE SHIELD
NYPC199OtherCENTER CARE
NY040426019577OtherFIDELIS
NY001315588OtherUNITED HEALTH CARE
NY01585602Medicaid
P393074OtherOXFORD HEALTH PLAN
519602OtherAETNA U.S. HEALTHCARE
NY01585602Medicaid