Individual
MR. BRUCE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1208 DRIVING PARK AVE, NEWARK, NY 14513-1057
(315) 359-2640
(315) 359-2645
Mailing address
1208 DRIVING PARK AVE, NEWARK, NY 14513-1057
(315) 359-2640
(315) 359-2645
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004516
NY
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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