Provider Demographics
NPI:1639263577
Name:LAI, KATHERINE (DPM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 56TH ST RM 1150
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3654
Mailing Address - Country:US
Mailing Address - Phone:212-980-6487
Mailing Address - Fax:212-980-8685
Practice Address - Street 1:120 E 56TH ST RM 1150
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3654
Practice Address - Country:US
Practice Address - Phone:212-980-6487
Practice Address - Fax:212-980-8685
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005009213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01493705Medicaid
NY480029242OtherINDIVIDUAL RR PROVIDER #
NYU49970Medicare UPIN
NY01493705Medicaid
NYP64741Medicare PIN