Provider Demographics
NPI:1972576114
Name:LAU, PAULINE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 MAIN ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6504
Mailing Address - Country:US
Mailing Address - Phone:718-353-1688
Mailing Address - Fax:718-353-2388
Practice Address - Street 1:3609 MAIN ST
Practice Address - Street 2:SUITE 6B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-353-1688
Practice Address - Fax:718-353-2388
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200907207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02233443Medicaid
NY02233443Medicaid
NY05416GMedicare ID - Type Unspecified