Provider Demographics
NPI:1922667104
Name:NG WU, LILEA MARIA
Entity Type:Individual
Prefix:
First Name:LILEA
Middle Name:MARIA
Last Name:NG WU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2044
Mailing Address - Country:US
Mailing Address - Phone:917-923-6099
Mailing Address - Fax:
Practice Address - Street 1:3919 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2044
Practice Address - Country:US
Practice Address - Phone:917-923-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy