Provider Demographics
NPI:1295779270
Name:LEE, BRUCE MINSHIK (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:MINSHIK
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 1:1555 LONG POND RD
Mailing Address - Street 2:DEPT. OF MEDICINE-HOSPITALIST
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7870
Mailing Address - Fax:585-723-7871
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:DEPT. OF MEDICINE-HOSPITALIST
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7870
Practice Address - Fax:585-723-7871
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232611207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY232611 4-W CIMOtherWORKER'S COMPENSATION
NY02565153Medicaid
NYRA2531- GRP:BA0017Medicare PIN
NYJ400023517-GRP70008AMedicare PIN
NYJ400023517-GRP70008AMedicare PIN