Provider Demographics
NPI:1558669804
Name:LEE, SOLOMON (DO)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:ACM LABORATORIES
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-429-2353
Mailing Address - Fax:585-723-7735
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:ACM LABORATORIES
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-429-2353
Practice Address - Fax:585-723-7735
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284200207ZP0102X
MI5101020831207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400328334-GRPBA0017Medicare PIN
NYJ400328330-GRP70008AMedicare PIN