Provider Demographics
NPI:1124259817
Name:LEE, GEORGE W (DPM)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 BEDFORD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2654
Mailing Address - Country:US
Mailing Address - Phone:347-596-9627
Mailing Address - Fax:
Practice Address - Street 1:135 CLINTON ST
Practice Address - Street 2:SUITE LB4
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3201
Practice Address - Country:US
Practice Address - Phone:516-486-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist