MEDICARE: YA-TSENG WILLIAM LU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MA50428	NJ
2	207L00000X	Anesthesiology Physician	185824	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	25MA05042800	OTHER	NJ	LICENSE

General Provider Information

NPI Number	:	1134162431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YA-TSENG WILLIAM LU MD

Provider Business Mailing Address
First Line	:	PO BOX 141277
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1277
Country	:	US
Telephone Number	:	718-815-1000
Fax Number	:	718-815-8122

Provider Business Practice Location Address
First Line	:	2015 FOREST AVE STE A3
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1736
Country	:	US
Telephone Number	:	718-815-1000
Fax Number	:	718-815-8122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	06/28/2020

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