Provider Demographics
NPI:1881969814
Name:JEFF LU, MD, P.C.
Entity type:Organization
Organization Name:JEFF LU, MD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HSIEN-YI
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-360-3372
Mailing Address - Street 1:740 VETERANS HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2329
Mailing Address - Country:US
Mailing Address - Phone:631-360-3372
Mailing Address - Fax:631-343-3125
Practice Address - Street 1:740 VETERANS HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2329
Practice Address - Country:US
Practice Address - Phone:631-360-3372
Practice Address - Fax:631-343-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225304261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH70039Medicare UPIN