Provider Demographics
NPI:1689855611
Name:TURKEL, LEE BLAKE (OD)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:BLAKE
Last Name:TURKEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 AVENUE C APT 7E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2328
Mailing Address - Country:US
Mailing Address - Phone:212-996-7676
Mailing Address - Fax:
Practice Address - Street 1:187 E 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1342
Practice Address - Country:US
Practice Address - Phone:212-996-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT003932-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00491630Medicaid
NYC2797-1Medicare PIN