Healthcare Provider Details

I. General information

NPI: 1437145802
Provider Name (Legal Business Name): PETER T LAO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

2221 146TH ST
WHITESTONE NY
11357-3521
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5020
  • Fax: 718-716-8736
Mailing address:
  • Phone: 718-445-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number038100
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number43868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: