MEDICARE: KEVIN LAU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	210536	NY

General Provider Information

NPI Number	:	1336130384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN LAU MD

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-0130
Country	:	US
Telephone Number	:	518-786-1291
Fax Number	:	518-786-1293

Provider Business Practice Location Address
First Line	:	4988 STATE HIGHWAY 30
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-7520
Country	:	US
Telephone Number	:	518-841-7203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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