Provider Demographics
NPI:1831249465
Name:LEE, YOUNG (MD)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 CAMPUSWOOD DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-234-6677
Mailing Address - Fax:315-234-4808
Practice Address - Street 1:5000 CAMPUSWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-234-6677
Practice Address - Fax:315-234-4808
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY221436207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02844746Medicaid
NY02844746Medicaid