Active NPI
Moon Lee, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1528072600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7336
- Practice address
- 1745 Broadway
17 FL
New York, NY 10019-4640 - Phone
- (212) 851-8102
- Fax
- (212) 537-0102
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7336 | NY | Primary |
Addresses
Primary practice location
1745 Broadway
17 FL
New York, NY 10019-4640
Mailing address
38 Radigan Ave
Staten Island, NY 10309-4212
Phone (718) 967-9145
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01879854 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7336 | NY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Che Senior Psychological Services, PC | Clinical | Past | Accepting new patients |
| Miriam Rozenberg Et Al Lily Pond Nursing Home | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Psychologist
- Brooklyn, NY
- NPI 1023078219
-
- Nursing Facility/Intermediate Care Facility
- Staten Island, NY
- NPI 1184834723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433894400000",
"number": "1528072600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 RADIGAN AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103094212",
"telephone_number": "718-967-9145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 BROADWAY",
"address_2": "17 FL",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100194640",
"telephone_number": "212-851-8102",
"fax_number": "212-537-0102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MOON",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2015-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "7336",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01879854",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.