Provider Demographics
NPI:1386682565
Name:LAO, ROGELIO S (MD)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:S
Last Name:LAO
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 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:34 COMMERCE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3118
Practice Address - Country:US
Practice Address - Phone:631-722-8880
Practice Address - Fax:631-722-7851
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00649243Medicaid
NY00649243Medicaid