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General NPI Number Information
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NPI Number | 1720535149
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Entity Type | Individual
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Provider Name | NAOMI RACHEL REBOLLO LEE MD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 3985 BROADWAY 168TH ST
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City | NEW YORK CITY
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State | NY
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Zip | 10032-0000
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Country | US
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Telephone | 929-546-5435
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Fax |
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Provider Business Mailing Address
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Address Line | 622 WEST 168TH ST VC-2 SUITE 260
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City | NEW YORK CITY
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State | NY
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Zip | 10032-0000
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Country | US
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Telephone | 787-462-3660
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 312258
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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