Provider Demographics
NPI:1558667527
Name:HENRY S, LAO MD PC
Entity Type:Organization
Organization Name:HENRY S, LAO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:SY
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-941-2000
Mailing Address - Street 1:1204 DITMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-6032
Mailing Address - Country:US
Mailing Address - Phone:718-941-2000
Mailing Address - Fax:718-284-9888
Practice Address - Street 1:1204 DITMAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-6032
Practice Address - Country:US
Practice Address - Phone:718-941-2000
Practice Address - Fax:718-284-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00225654Medicaid