MEDICARE: ERNEST LU

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	146N00000X	Basic Emergency Medical Technician	469954	NY

General Provider Information

NPI Number	:	1881214278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST LU

Provider Business Mailing Address
First Line	:	842 44TH ST APT 1R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1628
Country	:	US
Telephone Number	:	917-868-5918
Fax Number	:

Provider Business Practice Location Address
First Line	:	4218 MARATHON PKWY
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11363-1935
Country	:	US
Telephone Number	:	718-229-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2020
Last Update Date	:	04/25/2020

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Directions to “ ERNEST LU ” Practice Location

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