Organization
JUANITA O LAO MD PC
Active
Parent organization
JUANITA O LAO MD PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
JUANITA O LAO MD PC
Authorized official
DR. JUANITA ONG LAO MD (DIRECT OWNER)
(718) 789-1116
Entity
Organization
Contact information
Practice address
333 LAFAYETTE AVE, SUITE PB, BROOKLYN, NY 11238-1350
(718) 789-1116
Mailing address
121 DE KALB AVE., BROOKLYN, NY 11201-5425
(718) 789-1116
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
115220
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00211918
—
NY
Enumeration date
04/28/2011
Last updated
04/28/2011
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