Provider Demographics
NPI:1811052293
Name:LU, DAN (MD)
Entity type:Individual
Prefix:
First Name:DAN
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 - Credentials:
Mailing Address - Street 1:56 SHELBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1044
Mailing Address - Country:US
Mailing Address - Phone:516-244-3032
Mailing Address - Fax:516-270-2628
Practice Address - Street 1:199 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1536
Practice Address - Country:US
Practice Address - Phone:516-565-4110
Practice Address - Fax:516-565-3313
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY211410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154869Medicaid
NYG99940Medicare UPIN