Provider Demographics
NPI:1528492428
Name:LEE, PETER
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PROSE ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2315
Mailing Address - Country:US
Mailing Address - Phone:315-566-1032
Mailing Address - Fax:
Practice Address - Street 1:19304 HORACE HARDING EXPY
Practice Address - Street 2:APT.3H
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2892
Practice Address - Country:US
Practice Address - Phone:315-566-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711250131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist