Provider Demographics
NPI:1649273194
Name:LAO, HENRY SY (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:SY
Last Name:LAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1204 DITMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-6032
Mailing Address - Country:US
Mailing Address - Phone:718-941-2000
Mailing Address - Fax:718-284-9888
Practice Address - Street 1:1204 DITMAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-6032
Practice Address - Country:US
Practice Address - Phone:718-941-2000
Practice Address - Fax:718-284-9888
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY120158207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00225654Medicaid
B19834Medicare UPIN
NY898491Medicare ID - Type Unspecified