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General NPI Number Information
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NPI Number | 1306126107
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Entity Type | Individual
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Provider Name | JUN LU
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Gender | Female
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 3636 MAIN ST # 2SD
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City | FLUSHING
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State | NY
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Zip | 11354-6549
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Country | US
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Telephone | 347-345-7460
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Fax |
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Provider Business Mailing Address
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Address Line | 3636 MAIN ST # 2SD
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City | FLUSHING
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State | NY
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Zip | 11354-6549
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Country | US
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Telephone | 347-345-9460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 547289-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F305764-1
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License Number State | NY
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