Provider Demographics
NPI:1720535149
Name:REBOLLO LEE, NAOMI RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:RACHEL
Last Name:REBOLLO LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:RACHEL
Other - Last Name:REBOLLO RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 WEST 168TH ST
Mailing Address - Street 2:VC-2 SUITE 260
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10032-0000
Mailing Address - Country:US
Mailing Address - Phone:787-462-3660
Mailing Address - Fax:
Practice Address - Street 1:3985 BROADWAY 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10032-0000
Practice Address - Country:US
Practice Address - Phone:929-546-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312258207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program