Provider Demographics
NPI:1972601250
Name:LEE, JAY W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:W
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 1:1515 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1550
Mailing Address - Country:US
Mailing Address - Phone:614-252-0711
Mailing Address - Fax:614-252-9250
Practice Address - Street 1:1515 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1550
Practice Address - Country:US
Practice Address - Phone:614-252-0711
Practice Address - Fax:614-252-9250
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH418202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0403469Medicaid
OHLE2004181Medicare ID - Type Unspecified
OH0403469Medicaid