Provider Demographics
NPI:1093874919
Name:MAGENHEIM, LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:MAGENHEIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3914
Mailing Address - Country:US
Mailing Address - Phone:718-370-7500
Mailing Address - Fax:718-370-0850
Practice Address - Street 1:1944 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3914
Practice Address - Country:US
Practice Address - Phone:718-370-7500
Practice Address - Fax:718-370-0850
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX36251Medicare PIN