Provider Demographics
NPI:1528363330
Name:LEE, CHRISTOPHER RYAN (PHD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3125
Mailing Address - Country:US
Mailing Address - Phone:516-867-0500
Mailing Address - Fax:516-623-1296
Practice Address - Street 1:209 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3125
Practice Address - Country:US
Practice Address - Phone:516-867-0500
Practice Address - Fax:516-623-1296
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62033362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist