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General NPI Number Information
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NPI Number | 1316504376
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Entity Type | Individual
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Provider Name | ROY LEE
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Gender | Male
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1200 ROUTE 300
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City | NEWBURGH
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State | NY
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Zip | 12550-5003
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Country | US
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Telephone | 845-703-6999
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Fax | 845-703-6297
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Provider Business Mailing Address
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Address Line | 11800 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48093-3472
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 331211
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License Number State | NY
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