Provider Demographics
NPI:1780600718
Name:GUTERMAN, LEE (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:GUTERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ORCHARD PARK ROAD
Mailing Address - Street 2:SUITE A105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-677-6000
Mailing Address - Fax:716-677-6006
Practice Address - Street 1:4050 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4711
Practice Address - Country:US
Practice Address - Phone:716-803-1504
Practice Address - Fax:716-803-1508
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187667-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00524219007OtherBLUE CROSS/BLUE SHIELD
NY0608050OtherINDEPENDENT HEALTH
NY01651876Medicaid
NY00524219007OtherBLUE CROSS/BLUE SHIELD
NY0608050OtherINDEPENDENT HEALTH