Provider Demographics
NPI:1174830483
Name:ROBERT S. LEE THERAPEUTIC MASSAGE, P.C.
Entity Type:Organization
Organization Name:ROBERT S. LEE THERAPEUTIC MASSAGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SEUNGMIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT, RRT
Authorized Official - Phone:917-353-0953
Mailing Address - Street 1:2 COMET RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6909
Mailing Address - Country:US
Mailing Address - Phone:917-353-0953
Mailing Address - Fax:
Practice Address - Street 1:15301 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5035
Practice Address - Country:US
Practice Address - Phone:917-353-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023434-2261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center