Basic Information
Provider Information
NPI: 1053679621
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUI
FirstName: ROWENA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 68 S SERVICE RD STE 350
Address2:  
City: MELVILLE
State: NY
PostalCode: 117472358
CountryCode: US
TelephoneNumber: 5169453156
FaxNumber:  
Practice Location
Address1: 27005 76TH AVE DEPT OF
Address2:  
City: NEW HYDE PARK
State: NY
PostalCode: 110401402
CountryCode: US
TelephoneNumber: 7184707390
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/02/2012
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X289610NYY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home