Provider Demographics
NPI:1457792798
Name:LISA KIU LAW, M.D., PLLC
Entity Type:Organization
Organization Name:LISA KIU LAW, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KIU
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-227-1280
Mailing Address - Street 1:196 CANAL ST
Mailing Address - Street 2:# 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4562
Mailing Address - Country:US
Mailing Address - Phone:212-227-1280
Mailing Address - Fax:212-227-1270
Practice Address - Street 1:196 CANAL ST
Practice Address - Street 2:# 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4562
Practice Address - Country:US
Practice Address - Phone:212-227-1280
Practice Address - Fax:212-227-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261290207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03750841Medicaid
NYA100098254OtherMEDICARE
NY03681032Medicaid