Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 310535 | NY |
N | 208D00000X | General Practice Physician | MD466730 | PA |
NPI | 1114371754 |
---|---|
Provider Name | Richard Lau |
First Address | New York, NY 10016-2708 |
Second Address | New York, NY 10016-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 11/11/2021 |