Provider Demographics
NPI:1457421653
Name:LEE-REY, ELIZABETH T (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:LEE-REY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:T
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2426 EASTCHESTER RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5947
Mailing Address - Country:US
Mailing Address - Phone:718-708-5650
Mailing Address - Fax:718-708-5619
Practice Address - Street 1:2426 EASTCHESTER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5947
Practice Address - Country:US
Practice Address - Phone:718-708-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574996Medicaid
NY01574996Medicaid