MEDICARE: JENNIFER LAU MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	62 029646	NY
2	225100000X	Physical Therapist	40QA01466900	NJ

General Provider Information

NPI Number	:	1245552405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAU MPT

Provider Business Mailing Address
First Line	:	316 ACADEMY ST
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-1808
Country	:	US
Telephone Number	:	917-553-3941
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 ACADEMY ST
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-1808
Country	:	US
Telephone Number	:	917-553-3941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2010
Last Update Date	:	05/13/2013

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