Provider Demographics
NPI:1154732592
Name:LEE, RAYMOND SHANG JOONG (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:SHANG JOONG
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:59 BUSHWICK ST
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1201
Mailing Address - Country:US
Mailing Address - Phone:631-943-5219
Mailing Address - Fax:
Practice Address - Street 1:59 BUSHWICK ST
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1201
Practice Address - Country:US
Practice Address - Phone:631-943-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0159552084P0800X
NH211552084P0800X
PAOS0188872084P0800X
NC2018-004082084P0800X
NY3072082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry