Healthcare Provider Details

I. General information

NPI: 1073007712
Provider Name (Legal Business Name): TED LAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 04/18/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

1064 JACKSON AVE APT 4A
LONG ISLAND CITY NY
11101-6598
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7500
  • Fax:
Mailing address:
  • Phone: 925-209-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number310996
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: