MEDICARE: UNIVERSAL MEDICAL SERVICE, LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1598953721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MEDICAL SERVICE, LLC

Provider Business Mailing Address
First Line	:	821 45TH ST STE 101
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1610
Country	:	US
Telephone Number	:	718-972-1233
Fax Number	:	718-972-1277

Provider Business Practice Location Address
First Line	:	821 45TH ST STE 101
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5286
Country	:	US
Telephone Number	:	718-972-1233
Fax Number	:	718-972-1277

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. BING LU
Credential	:	MD, PHD
Telephone Number	:	718-972-1233

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	08/14/2020

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