Provider Demographics
NPI:1639674856
Name:XU, XIAOLU (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:XIAOLU
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 MILLBURN AVE # 132
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-4300
Mailing Address - Country:US
Mailing Address - Phone:203-492-9485
Mailing Address - Fax:
Practice Address - Street 1:820 PARK AVE # 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2758
Practice Address - Country:US
Practice Address - Phone:212-300-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329438208200000X
FLME169674208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME169674Medicaid