Provider Demographics
NPI:1043653660
Name:LU, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 61ST ST
Mailing Address - Street 2:FL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2635
Mailing Address - Country:US
Mailing Address - Phone:917-370-3600
Mailing Address - Fax:
Practice Address - Street 1:2319 61ST ST
Practice Address - Street 2:FL 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2635
Practice Address - Country:US
Practice Address - Phone:917-370-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist