MEDICARE: CANAL MEDICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	198051	NY

General Provider Information

NPI Number	:	1083983308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANAL MEDICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	221 CANAL ST
Second Line	:	SUITE 409
City	:	NEW YORK
State	:	NY
Zip	:	10013-4149
Country	:	US
Telephone Number	:	212-966-2178
Fax Number	:	212-925-7695

Provider Business Practice Location Address
First Line	:	221 CANAL ST
Second Line	:	SUITE 409
City	:	NEW YORK
State	:	NY
Zip	:	10013-4149
Country	:	US
Telephone Number	:	212-966-2178
Fax Number	:	212-925-7695

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. RONG-BAO LU
Credential	:	M.D.
Telephone Number	:	212-966-2178

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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