Provider Demographics
NPI:1669003265
Name:LU, JENNIFER YEELING (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YEELING
Last Name:LU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ROBIN ST APT 31
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3490
Mailing Address - Country:US
Mailing Address - Phone:248-635-9238
Mailing Address - Fax:
Practice Address - Street 1:100 NICHOLLS RD HSC T-9 ROOM 040
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-6270
Practice Address - Fax:631-444-3765
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program