Provider Demographics
NPI:1194784868
Name:LEE, PETER Y (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 CRANBURY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-613-0500
Mailing Address - Fax:732-613-0345
Practice Address - Street 1:557 CRANBURY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-613-0500
Practice Address - Fax:732-613-0345
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03594000207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0290408Medicaid
NJ0290408Medicaid
NJE36328Medicare UPIN