Provider Demographics
NPI:1578645990
Name:LEE, ERNEST J (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:J
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 1:624 MCCLELLAN ST
Mailing Address - Street 2:SUITE G01
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1020
Mailing Address - Country:US
Mailing Address - Phone:518-347-5655
Mailing Address - Fax:518-347-5656
Practice Address - Street 1:624 MCCLELLAN ST
Practice Address - Street 2:SUITE G01
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-347-5655
Practice Address - Fax:518-347-5656
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193404207Y00000X
HIMD-13421207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110022226001OtherCDPHP
219HE1OtherEMPIRE BLUE CROSS
9083054OtherMVP
NY01572238Medicaid
5369702OtherAETNA
NY01572238Medicaid
110022226001OtherCDPHP