Healthcare Provider Details

I. General information

NPI: 1033118229
Provider Name (Legal Business Name): RICHARD M. LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MERRICK RD SUITE 301
ROCKVILLE CENTRE NY
11570-5254
US

IV. Provider business mailing address

242 MERRICK RD SUITE 301
ROCKVILLE CENTRE NY
11570-5254
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-1455
  • Fax: 516-536-1598
Mailing address:
  • Phone: 516-536-1455
  • Fax: 516-536-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2287131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: