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General NPI Number Information
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NPI Number | 1174830483
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Entity Type | Organization
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Legal Business Name | ROBERT S. LEE THERAPEUTIC MASSAGE, P.C.
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 15301 NORTHERN BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-5035
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Country | US
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Telephone | 917-353-0953
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Fax |
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Provider Business Mailing Address
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Address Line | 2 COMET RD
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City | SYOSSET
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State | NY
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Zip | 11791-6909
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Country | US
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Telephone | 917-353-0953
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT SEUNGMIN LEE
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Credential | L.AC., LMT, RRT
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Telephone | 917-353-0953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 023434-2
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License Number State | NY
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