Healthcare Provider Details

I. General information

NPI: 1801983788
Provider Name (Legal Business Name): LEE AND BURACK OB/GYN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 HACKETT BLVD
ALBANY NY
12209-1718
US

IV. Provider business mailing address

62 HACKETT BLVD
ALBANY NY
12209-1718
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-3318
  • Fax: 518-449-1378
Mailing address:
  • Phone: 518-465-3318
  • Fax: 518-449-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN Y LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 518-465-3318