Provider Demographics
NPI:1083983308
Name:CANAL MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:CANAL MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONG-BAO
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-966-2178
Mailing Address - Street 1:221 CANAL ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4149
Mailing Address - Country:US
Mailing Address - Phone:212-966-2178
Mailing Address - Fax:212-925-7695
Practice Address - Street 1:221 CANAL ST
Practice Address - Street 2:SUITE 409
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4149
Practice Address - Country:US
Practice Address - Phone:212-966-2178
Practice Address - Fax:212-925-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198051261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY524331Medicare PIN