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General NPI Number Information
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NPI Number | 1770748634
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Entity Type | Organization
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Legal Business Name | FREDERICK LU MD PA
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 1156 LIBERTY AVE
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City | HILLSIDE
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State | NJ
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Zip | 07205
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Country | US
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Telephone | 908-527-9863
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Fax |
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Provider Business Mailing Address
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Address Line | 1156 LIBERTY AVE
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City | HILLSIDE
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State | NJ
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Zip | 07205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDERICK LU
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Credential | MD
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Telephone | 908-527-9863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA01980300
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License Number State |
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