Healthcare Provider Details

I. General information

NPI: 1154437333
Provider Name (Legal Business Name): LEE ANDREW MORGENTALER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 OLD TAPPAN RD
TAPPAN NY
10983-2401
US

IV. Provider business mailing address

580 ROUTE 303
BLAUVELT NY
10913-1105
US

V. Phone/Fax

Practice location:
  • Phone: 845-398-2873
  • Fax:
Mailing address:
  • Phone: 845-398-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: