Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 25MA10330200 | NJ |
NPI | 1164803284 |
---|---|
Provider Name | Sam Chuan Lu |
First Address | Hackensack, NJ 07601-1915 |
Second Address | Hackensack, NJ 07601-1915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2015 |
Last Update Date | 20/12/2018 |