Provider Demographics
NPI:1033118229
Name:LEE, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MERRICK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5254
Mailing Address - Country:US
Mailing Address - Phone:516-536-1455
Mailing Address - Fax:516-536-1598
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-536-1455
Practice Address - Fax:516-536-1598
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2287131207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02410915Medicaid
NY02410915Medicaid
W15181OtherGROUP#
57935Medicare ID - Type Unspecified