MEDICARE: DR. JOSHUA H LAU M.D.

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	208000000X	Pediatrics Physician	234775-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467422758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA H LAU M.D.

Provider Business Mailing Address
First Line	:	2079 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303
Country	:	US
Telephone Number	:	718-815-6560
Fax Number	:	718-815-6570

Provider Business Practice Location Address
First Line	:	2079 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303
Country	:	US
Telephone Number	:	718-815-6560
Fax Number	:	718-815-6570

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	04/29/2014

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