Provider Demographics
NPI:1861422958
Name:LEE, MARJORIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 THIRD AVENUE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7455
Mailing Address - Country:US
Mailing Address - Phone:212-533-1185
Mailing Address - Fax:212-533-1394
Practice Address - Street 1:247 THIRD AVENUE
Practice Address - Street 2:SUITE 403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7455
Practice Address - Country:US
Practice Address - Phone:212-533-1185
Practice Address - Fax:212-533-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126995207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00410191Medicaid
NY05A81Medicare ID - Type Unspecified
NY00410191Medicaid