Provider Demographics
NPI:1508909748
Name:KU, LAP C (PT LIC ACUP,)
Entity Type:Individual
Prefix:MR
First Name:LAP
Middle Name:C
Last Name:KU
Suffix:
Gender:M
Credentials:PT LIC ACUP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2309
Mailing Address - Country:US
Mailing Address - Phone:718-980-9888
Mailing Address - Fax:718-980-1403
Practice Address - Street 1:1481 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2309
Practice Address - Country:US
Practice Address - Phone:718-980-9888
Practice Address - Fax:718-980-1403
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001272-1171100000X
NY014071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQC3511Medicare ID - Type UnspecifiedPHYSICAL THERAPY