Individual
LEE MERRICK SHANGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 ROUTE 112, BLDG. 4 - 2ND FLOOR, PORT JEFFERSON STATION, NY 11776-8054
(631) 828-7001
(631) 928-0185
Mailing address
660 WHITE PLAINS RD FL 4, TARRYTOWN, NY 10591-5139
(914) 984-2546
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
172268-1
NY
207YS0012X
Sleep Medicine (Otolaryngology) Physician
Primary
172268
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1502405
—
NY
01
—
P01210116
RAILROAD MEDICARE PIN
NY
Enumeration date
11/09/2005
Last updated
01/23/2019
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