Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 243796 | NY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 25MA08573300 | NJ |
NPI | 1164407714 |
---|---|
Provider Name | Benjamin Lee |
First Address | New York, NY 10065-4870 |
Second Address | New York, NY 10065-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 18/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |