Individual provider Active NPI

Timothy Jerome Lee, DDS

  • General Practice Dentistry
  • Endicott, NY
National Provider Identifier
1285857771
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
046853-1 Issued in NY
Practice address
31 Adams Ave
Suite a
Endicott, NY 13760-5501
Phone
(607) 754-1999
NPI assigned
Apr 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 046853-1 NY Primary

Addresses

Primary practice location

31 Adams Ave
Suite a
Endicott, NY 13760-5501

Mailing address

31 Adams Ave
Suite a
Endicott, NY 13760-5501
Phone (607) 754-1999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150612001910 NY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0648581991

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046853-1NYMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285857771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 ADAMS AVE",
            "address_2": "SUITE A",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "137605501",
            "telephone_number": "607-754-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 ADAMS AVE",
            "address_2": "SUITE A",
            "city": "ENDICOTT",
            "state": "NY",
            "postal_code": "137605501",
            "telephone_number": "607-754-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "TIMOTHY",
        "middle_name": "JEROME",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "046853-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Endicott, NY

Sources for this page

Verify at the official NPI Registry.