Healthcare Provider Details

I. General information

NPI: 1225356728
Provider Name (Legal Business Name): OSTEOPATHIC MEDICINE AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BOWERY 3RD FLOOR
NEW YORK NY
10013-4615
US

IV. Provider business mailing address

17 ELIZABETH ST SUITE 601
NEW YORK NY
10013-4803
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 TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: WAH LEE
Title or Position: PHYSICIAN
Credential:
Phone: 917-204-8780