Healthcare Provider Details

I. General information

NPI: 1780600569
Provider Name (Legal Business Name): PETER Y LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD LABORATORY
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

2 COULTER RD ATTN: MEDICAL STAFF OFFICE
CLIFTON SPRINGS NY
14432-1122
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-1431
  • Fax: 315-462-7358
Mailing address:
  • Phone: 315-462-1464
  • Fax: 315-462-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number155958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: