Healthcare Provider Details

I. General information

NPI: 1609135995
Provider Name (Legal Business Name): DAN LU M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 09/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE BLDG RM15-265
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX 626
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1822
  • Fax:
Mailing address:
  • Phone: 585-275-3191
  • Fax: 585-273-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number280389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: