Provider Demographics
NPI:1326095688
Name:LU, STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:LU
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 1:1131 BROAD STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-578-9640
Mailing Address - Fax:732-578-9650
Practice Address - Street 1:1131 BROAD STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-578-9640
Practice Address - Fax:732-578-9650
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079604002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0081558Medicaid
NJ095237VA1Medicare PIN
NJ09537PZEMedicare PIN
I43744Medicare UPIN
NJP0037451Medicare PIN