Provider Demographics
NPI:1932510278
Name:PATRYLO, OKJU (DO)
Entity Type:Individual
Prefix:
First Name:OKJU
Middle Name:
Last Name:PATRYLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:OKJU
Other - Middle Name:
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2401 NORTHAMPTON ST STE 130
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2764
Practice Address - Country:US
Practice Address - Phone:484-591-7420
Practice Address - Fax:484-591-7421
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018814207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine