Provider Demographics
NPI:1679589667
Name:LEE, SIMON X (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:X
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 1:2 BEL AIR CT
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-2183
Mailing Address - Country:US
Mailing Address - Phone:732-419-3737
Mailing Address - Fax:732-419-3737
Practice Address - Street 1:903 60TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-438-0890
Practice Address - Fax:718-438-4279
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209983208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01897061Medicaid
G68730Medicare UPIN
NY01897061Medicaid