Healthcare Provider Details

I. General information

NPI: 1871014274
Provider Name (Legal Business Name): ROBERT LEE INTEGRATIVE CHIROPRACTIC & ACUPUNCTURE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COMET RD SIDE
SYOSSET NY
11791-6909
US

IV. Provider business mailing address

2 COMET RD SIDE
SYOSSET NY
11791-6909
US

V. Phone/Fax

Practice location:
  • Phone: 917-353-0953
  • Fax:
Mailing address:
  • Phone: 917-353-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number012933
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004025
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023434
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT SEUNGMIN LEE
Title or Position: PRESIDENT
Credential: DC, L.AC
Phone: 516-470-1826