Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 186405 | NY |
NPI | 1003976077 |
---|---|
Provider Name | Kevin S Lee |
First Address | Deer Park, NY 11729 |
Second Address | Deer Park, NY 11729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01665998 | (05) | NY |
G00734 | (02) |