MEDICARE: WAILIN LAU C.R.N.A

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	367500000X	Certified Registered Nurse Anesthetist	408317	NY

General Provider Information

NPI Number	:	1548266810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAILIN LAU C.R.N.A

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:
Fax Number	:	703-766-9725

Provider Business Practice Location Address
First Line	:	1650 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-7606
Country	:	US
Telephone Number	:	718-466-8153
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/26/2022

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