Provider Demographics
NPI:1689906695
Name:GAJANAN W LAUD MDPC
Entity Type:Organization
Organization Name:GAJANAN W LAUD MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAJANAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-424-0700
Mailing Address - Street 1:6647 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2540
Mailing Address - Country:US
Mailing Address - Phone:718-424-0700
Mailing Address - Fax:718-424-9708
Practice Address - Street 1:6647 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2540
Practice Address - Country:US
Practice Address - Phone:718-424-0700
Practice Address - Fax:718-424-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128638261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care