Healthcare Provider Details

I. General information

NPI: 1649273194
Provider Name (Legal Business Name): HENRY SY LAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 DITMAS AVE
BROOKLYN NY
11218-6032
US

IV. Provider business mailing address

1204 DITMAS AVE
BROOKLYN NY
11218-6032
US

V. Phone/Fax

Practice location:
  • Phone: 718-941-2000
  • Fax: 718-284-9888
Mailing address:
  • Phone: 718-941-2000
  • Fax: 718-284-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number120158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: