Provider Demographics
NPI:1760472575
Name:LEE, DEBORA (DO)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2016
Mailing Address - Country:US
Mailing Address - Phone:315-867-2700
Mailing Address - Fax:315-867-2825
Practice Address - Street 1:321 E ALBANY ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2016
Practice Address - Country:US
Practice Address - Phone:315-867-2700
Practice Address - Fax:315-867-2825
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221374-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02209781Medicaid
NYCC6886Medicare ID - Type UnspecifiedMEDICARE
NY02209781Medicaid