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General NPI Number Information
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NPI Number | 1346657103
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Entity Type | Individual
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Provider Name | TSZHODERRICK LUM DNP, NP-C
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Gender | Male
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Dates
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Enumeration Date | 07/14/2014
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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 | 718-701-8103
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Fax | 718-701-8103
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Provider Business Mailing 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 | 718-701-8103
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Fax | 718-701-8103
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R192541
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN1034607
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F338988
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024171969
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License Number State | VA
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