Provider Demographics
NPI:1598953721
Name:UNIVERSAL MEDICAL SERVICE, LLC
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BING
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:718-972-1233
Mailing Address - Street 1:821 45TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1610
Mailing Address - Country:US
Mailing Address - Phone:718-972-1233
Mailing Address - Fax:718-972-1277
Practice Address - Street 1:821 45TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5286
Practice Address - Country:US
Practice Address - Phone:718-972-1233
Practice Address - Fax:718-972-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UN0WDW2310Medicare PIN
H20158Medicare UPIN