Provider Demographics
NPI:1053421867
Name:LUE, FREDERICK C (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:LUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4007
Mailing Address - Country:US
Mailing Address - Phone:718-693-4121
Mailing Address - Fax:718-693-4787
Practice Address - Street 1:152 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4007
Practice Address - Country:US
Practice Address - Phone:718-693-4121
Practice Address - Fax:718-693-4787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00423836Medicaid
NY05A361Medicare ID - Type Unspecified
NY00423836Medicaid