Provider Demographics
NPI:1194883991
Name:LEE, STEPHEN S (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1649 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5202
Mailing Address - Country:US
Mailing Address - Phone:631-667-8178
Mailing Address - Fax:631-661-3859
Practice Address - Street 1:2704 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1343
Practice Address - Country:US
Practice Address - Phone:718-321-9090
Practice Address - Fax:718-661-3330
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY173043207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01355513Medicaid
F33715Medicare UPIN
NY01355513Medicaid