Provider Demographics
NPI:1831128214
Name:LEE, ALEX YIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:YIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:YIN
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:422 ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-8143
Mailing Address - Country:US
Mailing Address - Phone:516-596-0527
Mailing Address - Fax:516-596-9271
Practice Address - Street 1:422 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-8143
Practice Address - Country:US
Practice Address - Phone:516-596-0527
Practice Address - Fax:516-596-9271
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400072747Medicare PIN
NYG400075934Medicare PIN
NYG36009Medicare UPIN
NY01678266Medicare ID - Type Unspecified