Healthcare Provider Details

I. General information

NPI: 1770748634
Provider Name (Legal Business Name): FREDERICK LU MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 LIBERTY AVE
HILLSIDE NJ
07205
US

IV. Provider business mailing address

1156 LIBERTY AVE
HILLSIDE NJ
07205
US

V. Phone/Fax

Practice location:
  • Phone: 908-527-9863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA01980300
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK LU
Title or Position: OWNER
Credential: MD
Phone: 908-527-9863