Healthcare Provider Details

I. General information

NPI: 1871725879
Provider Name (Legal Business Name): LAU YAN TOA RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 CANAL ST
NEW YORK NY
10013
US

IV. Provider business mailing address

1571 79TH ST
BROOKLYN NY
11228-2523
US

V. Phone/Fax

Practice location:
  • Phone: 212-379-6998
  • Fax: 212-941-2186
Mailing address:
  • Phone: 718-331-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number493671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number493671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: