Provider Demographics
NPI:1376608661
Name:AUSTIN LU MEDICAL P.L.L.C.
Entity Type:Organization
Organization Name:AUSTIN LU MEDICAL P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-966-5882
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4552
Mailing Address - Country:US
Mailing Address - Phone:212-966-5882
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:SUITE 506
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4552
Practice Address - Country:US
Practice Address - Phone:212-966-5882
Practice Address - Fax:212-966-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579184Medicaid
NYE83949Medicare UPIN
NY01579184Medicaid