Healthcare Provider Details

I. General information

NPI: 1841289998
Provider Name (Legal Business Name): VINCENT PATRICK LEE RN, NP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 BROOKHAVEN DR
ROCKY POINT NY
11778-9355
US

IV. Provider business mailing address

69 BROOKHAVEN DR
ROCKY POINT NY
11778-9355
US

V. Phone/Fax

Practice location:
  • Phone: 631-744-2614
  • Fax: 631-849-3542
Mailing address:
  • Phone: 631-744-2614
  • Fax: 631-849-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberF340309-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: