MEDICARE: NAOMI RACHEL REBOLLO LEE MD

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	207P00000X	Emergency Medicine Physician	312258	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720535149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI RACHEL REBOLLO LEE MD

Provider Business Mailing Address
First Line	:	622 WEST 168TH ST
Second Line	:	VC-2 SUITE 260
City	:	NEW YORK CITY
State	:	NY
Zip	:	10032-0000
Country	:	US
Telephone Number	:	787-462-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	3985 BROADWAY 168TH ST
Second Line	:
City	:	NEW YORK CITY
State	:	NY
Zip	:	10032-0000
Country	:	US
Telephone Number	:	929-546-5435
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	02/29/2024

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