Provider Demographics
NPI:1780600569
Name:LEE, PETER Y (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 COULTER RD
Mailing Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1122
Mailing Address - Country:US
Mailing Address - Phone:315-462-1464
Mailing Address - Fax:315-462-2487
Practice Address - Street 1:2 COULTER RD
Practice Address - Street 2:LABORATORY
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-1431
Practice Address - Fax:315-462-7358
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY155958207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE41576Medicare UPIN