MEDICARE: KRYSTAL LEE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	323981	NY

General Provider Information

NPI Number	:	1720472939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL LEE DO

Provider Business Mailing Address
First Line	:	1554 NORTHERN BLVD FL 4
Second Line	:
City	:	MANHASSET
State	:	NY
Zip	:	11030-3053
Country	:	US
Telephone Number	:	516-321-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 QUEENS BLVD STE 501
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4503
Country	:	US
Telephone Number	:	718-460-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	09/05/2024

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Directions to “ KRYSTAL LEE DO” Practice Location

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