Provider Demographics
NPI:1366012049
Name:LIU, LU LU
Entity Type:Individual
Prefix:
First Name:LU LU
Middle Name:
Last Name:LIU
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 1:8710 149TH AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1442
Mailing Address - Country:US
Mailing Address - Phone:091-778-9110
Mailing Address - Fax:
Practice Address - Street 1:323 E MIDDLE COUNTRY RD STE 3
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2822
Practice Address - Country:US
Practice Address - Phone:631-780-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty