Provider Demographics
NPI:1801044193
Name:TAY, JU LEE (MD)
Entity Type:Individual
Prefix:
First Name:JU LEE
Middle Name:
Last Name:TAY
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 1:1628 CHEW STREET
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105
Mailing Address - Country:US
Mailing Address - Phone:610-969-4970
Mailing Address - Fax:610-969-4952
Practice Address - Street 1:1628 CHEW STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105
Practice Address - Country:US
Practice Address - Phone:610-969-4970
Practice Address - Fax:610-969-4952
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine