Healthcare Provider Details

I. General information

NPI: 1275970188
Provider Name (Legal Business Name): LEE SQUITIERI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 EASTCHESTER RD STE 200
BRONX NY
10461-2334
US

IV. Provider business mailing address

5 SHADY RD
ARDSLEY NY
10502-2221
US

V. Phone/Fax

Practice location:
  • Phone: 516-650-8439
  • Fax:
Mailing address:
  • Phone: 516-650-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA 125392
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number339647-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: