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General NPI Number Information
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NPI Number | 1174221584
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Entity Type | Organization
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Legal Business Name | TSZ HO DERRICK LUM FAMILY HEALTH NP, P.C.
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 1424 RICHMOND AVE STE C
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1527
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Country | US
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Telephone | 646-763-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 708 BAYSIDE CT
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City | SOUTH AMBOY
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State | NJ
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Zip | 08879-1981
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Country | US
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Telephone | 347-987-1038
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TSZHODERRICK LUM
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Credential | DNP
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Telephone | 347-987-1038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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