Healthcare Provider Details

I. General information

NPI: 1679622112
Provider Name (Legal Business Name): LEE REHABILITATION OSTEOPATHIC MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8672 188TH ST
HOLLIS NY
11423-1110
US

IV. Provider business mailing address

42 BAY 31ST ST 2ND FLOOR
BROOKLYN NY
11214-4110
US

V. Phone/Fax

Practice location:
  • Phone: 917-204-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2310351
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2310351
License Number StateNY

VIII. Authorized Official

Name: DR. WAH LEE
Title or Position: OWNER
Credential: DO
Phone: 917-204-8780