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General NPI Number Information
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NPI Number | 1639674856
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Entity Type | Individual
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Provider Name | XIAOLU XU MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 820 PARK AVE # 1B
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City | NEW YORK
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State | NY
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Zip | 10021-2758
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Country | US
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Telephone | 212-300-9873
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Fax |
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Provider Business Mailing Address
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Address Line | 92 MILLBURN AVE # 132
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-4300
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Country | US
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Telephone | 203-492-9485
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 329438
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME169674
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License Number State | FL
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