Provider Demographics
NPI:1568649135
Name:LAU, RAYMOND G (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:G
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:157 E WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1423
Mailing Address - Country:US
Mailing Address - Phone:631-475-1900
Mailing Address - Fax:
Practice Address - Street 1:157 E WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1423
Practice Address - Country:US
Practice Address - Phone:631-475-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-26
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258312208600000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208600000XAllopathic & Osteopathic PhysiciansSurgery