Provider Demographics
NPI:1629067889
Name:HURNEY, LEE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:M
Last Name:HURNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MONTOWESE ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3809
Mailing Address - Country:US
Mailing Address - Phone:203-481-8969
Mailing Address - Fax:203-483-8106
Practice Address - Street 1:125 MONTOWESE ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3809
Practice Address - Country:US
Practice Address - Phone:203-481-8969
Practice Address - Fax:203-483-8106
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000087213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480001047OtherST RAPHAEL FACULTY PHYSICIAN MEDICARE
CTT23497Medicare UPIN
CT480000400Medicare ID - Type Unspecified