Healthcare Provider Details

I. General information

NPI: 1053586792
Provider Name (Legal Business Name): ANDREW KING-KEI LAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE SUITE 11-G
BRONX NY
10457-7626
US

IV. Provider business mailing address

1650 SELWYN AVE SUITE 11-G
BRONX NY
10457-7626
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-8151
  • Fax: 718-466-8155
Mailing address:
  • Phone: 718-466-8151
  • Fax: 718-466-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08796000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number257076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: