Provider Demographics
NPI:1871014274
Name:ROBERT LEE INTEGRATIVE CHIROPRACTIC & ACUPUNCTURE, P.C.
Entity Type:Organization
Organization Name:ROBERT LEE INTEGRATIVE CHIROPRACTIC & ACUPUNCTURE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SEUNGMIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:516-470-1826
Mailing Address - Street 1:2 COMET RD SIDE
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 1:2 COMET RD SIDE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6909
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:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012933111N00000X
NY004025171100000X
NY023434225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05469636Medicaid