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General NPI Number Information
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NPI Number | 1720472939
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Entity Type | Individual
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Provider Name | KRYSTAL LEE DO
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Gender | Female
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 9525 QUEENS BLVD STE 501
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City | REGO PARK
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State | NY
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Zip | 11374-4503
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Country | US
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Telephone | 718-460-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1554 NORTHERN BLVD FL 4
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City | MANHASSET
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State | NY
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Zip | 11030-3053
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Country | US
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Telephone | 516-321-6400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 323981
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License Number State | NY
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