MEDICARE: DR. SHING HONG 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	207V00000X	Obstetrics & Gynecology Physician	25MA03477400	NJ
2	208D00000X	General Practice Physician	25MA03477400	NJ

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

General Provider Information

NPI Number	:	1285626721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHING HONG LU MD

Provider Business Mailing Address
First Line	:	109 BENEDICT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-2463
Country	:	US
Telephone Number	:	718-420-0960
Fax Number	:	718-420-0960

Provider Business Practice Location Address
First Line	:	680 BROADWAY
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07514-1422
Country	:	US
Telephone Number	:	732-212-0060
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	11/03/2008

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Directions to “ DR. SHING HONG LU MD” Practice Location

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