Provider Demographics
NPI:1063857142
Name:LAU, JANET (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HILLSIDE AVE APT 10G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2720
Mailing Address - Country:US
Mailing Address - Phone:917-238-4714
Mailing Address - Fax:
Practice Address - Street 1:99 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2715
Practice Address - Country:US
Practice Address - Phone:917-238-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005962-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005962-1OtherLICENSE
NY926217OtherREGISTERED DIETITIAN
NY47013007OtherCERTIFICATE