Provider Demographics
NPI:1285664045
Name:LUM, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:LUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 MAPLE AVE
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3865
Mailing Address - Country:US
Mailing Address - Phone:718-886-8251
Mailing Address - Fax:
Practice Address - Street 1:13630 MAPLE AVE
Practice Address - Street 2:SUITE 1J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3865
Practice Address - Country:US
Practice Address - Phone:718-886-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01041372Medicaid
NY01250UMedicare ID - Type Unspecified
NY01041372Medicaid