Healthcare Provider Details

I. General information

NPI: 1164485280
Provider Name (Legal Business Name): DANIEL C LAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 W STATE ST SUITE 102
OLEAN NY
14760-1938
US

IV. Provider business mailing address

2223 W STATE ST SUITE 102
OLEAN NY
14760-1938
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-7205
  • Fax:
Mailing address:
  • Phone: 716-372-7205
  • Fax: 716-372-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2173741
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02079463
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: