Provider Demographics
NPI:1306808852
Name:LU, YU-DER AGNES (RD)
Entity type:Individual
Prefix:
First Name:YU-DER
Middle Name:AGNES
Last Name:LU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EAST MAIN ST
Mailing Address - Street 2:MEDICAL AFFAIRS NORTHERN WESTCHESTER HOSPITAL
Mailing Address - City:MT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-242-8318
Mailing Address - Fax:914-666-1965
Practice Address - Street 1:400 EAST MAIN ST
Practice Address - Street 2:NUTRITIONAL SERVICES NORTHERN WESTCHESTER HOSPITAL
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-1465
Practice Address - Fax:914-666-1787
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001654133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q63929Medicare UPIN
NY9531EFW071Medicare PIN
NY9531E1Medicare PIN