Provider Demographics
NPI:1255484440
Name:LAUD, GAJANAN W (MD)
Entity Type:Individual
Prefix:
First Name:GAJANAN
Middle Name:W
Last Name:LAUD
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 1:6647 GRAND AVE
Mailing Address - Street 2:MASPETH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11378
Mailing Address - Country:US
Mailing Address - Phone:718-424-0700
Mailing Address - Fax:718-424-9708
Practice Address - Street 1:6647 GRAND AVE
Practice Address - Street 2:MASPETH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11378
Practice Address - Country:US
Practice Address - Phone:718-424-0700
Practice Address - Fax:718-424-9708
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00302130Medicaid
NY49976Medicare ID - Type Unspecified
D79307Medicare UPIN