MEDICARE: DR. GEORGE W LEE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N004500	NY

General Provider Information

NPI Number	:	1124259817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE W LEE DPM

Provider Business Mailing Address
First Line	:	4650 BEDFORD AVE
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2654
Country	:	US
Telephone Number	:	347-596-9627
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 CLINTON ST
Second Line	:	SUITE LB4
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-3201
Country	:	US
Telephone Number	:	516-486-1125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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