Bruce Lee, PA

Physician Assistant · Newark, NY

Individual Active NPI

NPI number 1689757288

Practice location

1208 Driving Park Ave
Newark, NY 14513-1057
Phone
(315) 359-2640
Fax
(315) 359-2645

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NPI record

NPI
1689757288
Entity type
Individual (Type 1)
Enumeration date
October 24, 2006
Last updated
July 8, 2007
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 004516 NY

About Bruce Lee

Bruce Lee, PA is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 1208 Driving Park Ave, Newark, NY 14513-1057. The NPI number 1689757288 was assigned on October 24, 2006 and the record was last updated on July 8, 2007.

Bruce Lee lists a license in the registry: #004516 (NY) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Bruce Lee, PA?

The NPI number is 1689757288.

What is the phone number of Bruce Lee?

The phone number listed for the practice location is (315) 359-2640.

Where is Bruce Lee located?

1208 Driving Park Ave, Newark, NY 14513-1057.

What is the taxonomy code for Bruce Lee?

The primary taxonomy code is 363A00000X – Physician Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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