Provider Demographics
NPI:1518986298
Name:POMERANZ, LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:POMERANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-0560
Mailing Address - Country:US
Mailing Address - Phone:516-822-7874
Mailing Address - Fax:516-822-3637
Practice Address - Street 1:95 BROADHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2506
Practice Address - Country:US
Practice Address - Phone:516-822-7874
Practice Address - Fax:516-822-3637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146133174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00906872Medicaid
NY15D751Medicare ID - Type Unspecified
NYC06012Medicare UPIN