MEDICARE: MR. VINCENT PATRICK LEE RN, NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	F340309-1	NY

General Provider Information

NPI Number	:	1841289998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT PATRICK LEE RN, NP

Provider Business Mailing Address
First Line	:	69 BROOKHAVEN DR
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-9355
Country	:	US
Telephone Number	:	631-744-2614
Fax Number	:	631-849-3542

Provider Business Practice Location Address
First Line	:	69 BROOKHAVEN DR
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-9355
Country	:	US
Telephone Number	:	631-744-2614
Fax Number	:	631-849-3542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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