Individual provider Active NPI

Raymond Shang Joong Lee, D.O.

  • Psychiatry Physician
  • Melville, NY
National Provider Identifier
1154732592
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
307208 Issued in NY
Practice address
59 Bushwick St
Melville, NY 11747-1201
Phone
(631) 943-5219
NPI assigned
May 19, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X OT015955 PA
Psychiatry Physician 2084P0800X 21155 NH
Psychiatry Physician 2084P0800X OS018887 PA
Psychiatry Physician 2084P0800X 2018-00408 NC
Psychiatry Physician 2084P0800X 307208 NY Primary

Addresses

Primary practice location

59 Bushwick St
Melville, NY 11747-1201

Mailing address

59 Bushwick St
Melville, NY 11747-1201
Phone (631) 943-5219

Other practice location 1

5515 Peach St
Erie, PA 16509-2603
Phone (814) 864-4031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210511002426 NY Practitioner - PsychiatryPractitioner - Osteopathic Manipulative Medicine 1254740814 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2018-00408NCMDPsychiatry Physician
21155NHMDPsychiatry Physician
OS018887PAMDPsychiatry Physician
OT015955PAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation CurrentSince Apr 27, 2021 Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Apr 27, 2021 Accepting new patients
University Hospital at Stony Brook Current Accepting new patients
New York City Health and Hospitals Corporation Current Accepting new patients

Locations

7901 Broadway
Flushing, NY 11373
Phone (718) 334-2156

8268 164th St
Jamaica, NY 11432
Phone (718) 883-2929

50 Water St
Fl 3
New York, NY 10004

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: raymond.lee@direct.stonybrookmedicine.edu
  • Direct secure messaging: rlee1600921@nychhc.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1154732592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 BUSHWICK ST",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117471201",
            "telephone_number": "631-943-5219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 BUSHWICK ST",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117471201",
            "telephone_number": "631-943-5219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5515 Peach St",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165092603",
            "country_code": "US",
            "telephone_number": "814-864-4031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "RAYMOND",
        "middle_name": "SHANG JOONG",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-19",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "OT015955",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NH",
            "license": "21155",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "OS018887",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2018-00408",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "307208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melville, NY

Sources for this page

Verify at the official NPI Registry.