Provider Demographics
NPI:1982694600
Name:LEE, WILL W (MD)
Entity type:Individual
Prefix:MR
First Name:WILL
Middle Name:W
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 1:213 MADISON AVE
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-725-0123
Mailing Address - Fax:212-725-3738
Practice Address - Street 1:213 MADISON AVE
Practice Address - Street 2:SUITE #1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-725-0123
Practice Address - Fax:212-725-3738
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82145207V00000X
NY220260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02245150Medicaid
H33852Medicare UPIN
IA0784Medicare ID - Type Unspecified