Provider Information for 1417099128
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JUN LU MD
Sex: Female
NPI: 1417099128
Last Updated: 2022-09-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
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| NPI | 1417099128 | ||||||||||||||
| Enumeration Date | 2007-02-12 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE PROVIDER ENROLLMENT - ELLIE ATKINS FARMINGTON, CT 06030-2212 United States Phone: 860-679-7503 | Fax:860-679-1610 | ||||||||||||||
| Primary Practice Address | 21 SOUTH RD DERMATOLOGY FARMINGTON, CT 06032-2482 United States Phone: 860-679-4600 | Fax:860-679-1248 | ||||||||||||||
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