Healthcare Provider Details

I. General information

NPI: 1427502681
Provider Name (Legal Business Name): CHRISTINA LAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 8TH AVE
BROOKLYN NY
11220-4718
US

IV. Provider business mailing address

1309 SHORE PKWY
BROOKLYN NY
11214-6006
US

V. Phone/Fax

Practice location:
  • Phone: 718-765-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: