Provider Demographics
NPI:1083787071
Name:LAI, YU JEN (MD)
Entity Type:Individual
Prefix:
First Name:YU JEN
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BELLE TERRE RD
Mailing Address - Street 2:SUITE E740
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-474-6879
Mailing Address - Fax:631-474-6448
Practice Address - Street 1:200 BELLE TERRE RD
Practice Address - Street 2:SUITE E740
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-474-6879
Practice Address - Fax:631-474-6448
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY211328208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01898493Medicaid
NY01898493Medicaid
NY024Z751Medicare ID - Type Unspecified