Provider Demographics
NPI:1255803359
Name:LEE, HWAL (PA)
Entity type:Individual
Prefix:
First Name:HWAL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:407 ALBANY SHAKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1962
Mailing Address - Country:US
Mailing Address - Phone:518-435-1300
Mailing Address - Fax:518-435-1397
Practice Address - Street 1:407 ALBANY SHAKER RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1962
Practice Address - Country:US
Practice Address - Phone:518-435-1300
Practice Address - Fax:518-435-1397
Is Sole Proprietor?:No
Enumeration Date:2018-12-30
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY026325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995513Medicaid
NY331833OtherMEDICARE OSCAR
NY53099AOtherMEDICARE PIN