Provider Demographics
NPI:1699959411
Name:LEE MIU, KAREN LAI PING
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LAI PING
Last Name:LEE MIU
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 1:8324 124TH PL
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2704
Mailing Address - Country:US
Mailing Address - Phone:718-805-6711
Mailing Address - Fax:718-456-2832
Practice Address - Street 1:5711 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4933
Practice Address - Country:US
Practice Address - Phone:718-456-2672
Practice Address - Fax:718-456-2832
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01438908Medicaid