Provider Demographics
NPI:1427009430
Name:LU, CHAO (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAO
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 1:109 LAFAYETTE STREET
Mailing Address - Street 2:ROOM C-1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4138
Mailing Address - Country:US
Mailing Address - Phone:212-219-0534
Mailing Address - Fax:212-219-0535
Practice Address - Street 1:109 LAFAYETTE STREET
Practice Address - Street 2:ROOM C-1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4138
Practice Address - Country:US
Practice Address - Phone:212-219-0534
Practice Address - Fax:212-219-0535
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226523208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02356334Medicaid
0149J1Medicare UPIN