Provider Demographics
NPI:1902005960
Name:LAU, RAYMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SUTTON CT
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3943
Mailing Address - Country:US
Mailing Address - Phone:646-808-4471
Mailing Address - Fax:
Practice Address - Street 1:89 BOWERY
Practice Address - Street 2:CELLAR LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:646-885-1399
Practice Address - Fax:646-885-1359
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10207000207Q00000X
NY237857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY237857OtherLICESE