Active NPI
Bruce Lee, PA
- Physician Assistant
- Newark, NY
National Provider Identifier
1689757288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 004516
- Practice address
- 1208 Driving Park Ave
Newark, NY 14513-1057 - Phone
- (315) 359-2640
- Fax
- (315) 359-2645
- NPI assigned
- Oct 24, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004516 | NY | Primary |
Addresses
Primary practice location
1208 Driving Park Ave
Newark, NY 14513-1057
Mailing address
1208 Driving Park Ave
Newark, NY 14513-1057
Phone (315) 359-2640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004516 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689757288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1208 DRIVING PARK AVE",
"city": "NEWARK",
"state": "NY",
"postal_code": "145131057",
"telephone_number": "315-359-2640",
"fax_number": "315-359-2645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 DRIVING PARK AVE",
"city": "NEWARK",
"state": "NY",
"postal_code": "145131057",
"telephone_number": "315-359-2640",
"fax_number": "315-359-2645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "BRUCE",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "004516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.