Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 132304 | NY |
NPI | 1003818477 |
---|---|
Provider Name | Dr. Allen L Lee |
First Address | Brooklyn, NY 11209-1604 |
Second Address | Brooklyn, NY 11209-1604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 04/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0022001 | GHI (01) | NY |
521682 | AETNA US HEALTHCARE (01) | NY |
5726D1 | EMPIREBLUECROSSBLUESHIELD (01) | NY |
C05680 | (02) | |
P1126622 | OXFORD (01) | NY |