Provider Demographics
NPI:1194802686
Name:LU, FONG (MD)
Entity type:Individual
Prefix:
First Name:FONG
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 07 PRINCE STREET 4A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-661-9909
Mailing Address - Fax:718-661-0977
Practice Address - Street 1:39 07 PRINCE STREET 4A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-661-9909
Practice Address - Fax:718-661-0977
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205684208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061569754OtherMAGNACARE
NY061569754OtherTOUCHSTON
NY1C3833OtherEMPIRE BCBS
NY205684A29OtherHEALTHFIRST
NY205684OtherHIP
NY2323750OtherAETNA HMO
NY1647829002OtherCIGNA
NY3811159Other1199
NY7952060OtherAETNA PPO
NY2799825OtherGHI PPO
NY361100700OtherACS OWCP
NYP1998379OtherOXFORD
NY1000048551OtherAFFINITY HEALTH PLAN
NY100195576601OtherUNITED HEALTHCARE
NY286473OtherWELLCARE
NY2C5249OtherHEALTHNET
NY061569754OtherMETROPLUS