MEDICARE: BRANT LAI

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	208D00000X	General Practice Physician	MD493909	PA
2	208D00000X	General Practice Physician	4301516023	MI
3	390200000X	Student in an Organized Health Care Education/Training Program
4	208D00000X	General Practice Physician	35.155317	OH

General Provider Information

NPI Number	:	1881273415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANT LAI

Provider Business Mailing Address
First Line	:	101 NICOLLS RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 NICOLLS RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:	631-689-8333
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	02/14/2026

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Directions to “ BRANT LAI ” Practice Location

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