Provider Demographics
NPI:1801821293
Name:LEE, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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 1:622 W 168 ST PH 1 137
Mailing Address - Street 2:ASSOCIATES IN EMERGENCY SERVICES CUMC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3784
Mailing Address - Country:US
Mailing Address - Phone:212-305-2995
Mailing Address - Fax:212-305-6792
Practice Address - Street 1:622 W 168 ST PH 1 137
Practice Address - Street 2:ASSOCIATES IN EMERGENCY SERVICES CUMC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3784
Practice Address - Country:US
Practice Address - Phone:212-305-2995
Practice Address - Fax:212-305-6792
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-07-19
Deactivation Code:
Reactivation Date:2006-11-08
Provider Licenses
StateLicense IDTaxonomies
NY217416207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02166241Medicaid
H44217Medicare UPIN
NY02166241Medicaid