Provider Demographics
NPI:1205232402
Name:LAI, RICHARD (DPT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 CUNNINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-5358
Mailing Address - Country:US
Mailing Address - Phone:973-288-3056
Mailing Address - Fax:
Practice Address - Street 1:66 JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1970
Practice Address - Country:US
Practice Address - Phone:973-288-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-15
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01530400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist