Provider Demographics
NPI:1801844246
Name:LEE, B. EUN (MD)
Entity Type:Individual
Prefix:DR
First Name:B.
Middle Name:EUN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:EUN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:233 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3812
Mailing Address - Country:US
Mailing Address - Phone:716-433-5269
Mailing Address - Fax:716-433-6005
Practice Address - Street 1:233 EAST AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3812
Practice Address - Country:US
Practice Address - Phone:716-433-5269
Practice Address - Fax:716-433-6005
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130038-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00629245Medicaid
NYB36060Medicare UPIN
NY00629245Medicaid