Provider Demographics
NPI:1851532600
Name:LU, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
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 1:1050 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1548
Mailing Address - Country:US
Mailing Address - Phone:732-283-2663
Mailing Address - Fax:732-283-2661
Practice Address - Street 1:1050 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1548
Practice Address - Country:US
Practice Address - Phone:732-283-2663
Practice Address - Fax:732-283-2661
Is Sole Proprietor?:No
Enumeration Date:2009-03-07
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08962800207X00000X
PAMD439946207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0274950Medicaid
NJ229545Medicare PIN