Active NPI
Edward Jin Lee, MD
- Vascular Neurology Physician
- New York, NY
National Provider Identifier
1568091460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Neurology Physician
- License
- 329352
- Practice address
- 630 W 168TH St
New York, NY 10032-3725 - Phone
- (551) 795-6727
- NPI assigned
- Apr 3, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Neurology Physician | 2084V0102X | 329352 | NY | Primary |
Addresses
Primary practice location
630 W 168TH St
New York, NY 10032-3725
Mailing address
4444 W Pine Blvd Apt 111
Saint Louis, MO 63108-2347
Phone (551) 795-6727
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250715003141 | NY | Order and Referring Only - Neurology | 7012422371 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
Interoperability endpoints
- elee4094408@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758585600000",
"number": "1568091460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4444 W PINE BLVD APT 111",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631082347",
"telephone_number": "551-795-6727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 W 168TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323725",
"telephone_number": "551-795-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "EDWARD",
"middle_name": "JIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-03",
"last_updated": "2025-09-23",
"certification_date": "2025-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084V0102X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Vascular Neurology",
"state": "NY",
"license": "329352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.