Active NPI
Lee Regenbogen
- Specialist
- Staten Island, NY
National Provider Identifier
1679979496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 859958141
- Practice address
- 639 Rensselaer Ave
Staten Island, NY 10312-2725 - Phone
- (917) 861-5200
- NPI assigned
- Nov 5, 2014
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 859958141 | NY | Primary |
Addresses
Primary practice location
639 Rensselaer Ave
Staten Island, NY 10312-2725
Mailing address
639 Rensselaer Ave
Staten Island, NY 10312-2725
Phone (917) 861-5200
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 859958141 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415145600000",
"number": "1679979496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "639 RENSSELAER AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103122725",
"telephone_number": "917-861-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 RENSSELAER AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103122725",
"telephone_number": "917-861-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REGENBOGEN",
"first_name": "LEE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-05",
"last_updated": "2014-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "859958141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.