Provider Demographics
NPI:1518183730
Name:LUM, ISIS CHEN LAN (L AC)
Entity Type:Individual
Prefix:
First Name:ISIS CHEN LAN
Middle Name:
Last Name:LUM
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEW PALTZ POST OFFICE
Mailing Address - Street 2:POB 484
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-399-9002
Mailing Address - Fax:
Practice Address - Street 1:232 RIVER RD.
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487
Practice Address - Country:US
Practice Address - Phone:845-399-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist