Provider Demographics
NPI:1013304161
Name:REBECCA LU MD
Entity Type:Organization
Organization Name:REBECCA LU MD
Other - Org Name:ELITE SKINMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-722-6788
Mailing Address - Street 1:7 MOUNT BETHEL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2636
Mailing Address - Country:US
Mailing Address - Phone:908-787-8088
Mailing Address - Fax:908-368-8648
Practice Address - Street 1:7 MOUNT BETHEL RD
Practice Address - Street 2:SUITE C
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2636
Practice Address - Country:US
Practice Address - Phone:908-787-8088
Practice Address - Fax:908-368-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08557200207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ433674Medicare PIN