Provider Demographics
NPI:1538235890
Name:LAU, ANTHONY CK (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CK
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 JORDAN WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3776
Mailing Address - Country:US
Mailing Address - Phone:609-655-7883
Mailing Address - Fax:
Practice Address - Street 1:10 ESQUIRE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3336
Practice Address - Country:US
Practice Address - Phone:845-638-9888
Practice Address - Fax:845-638-9888
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114627208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY656871Medicare ID - Type Unspecified
NYB78734Medicare UPIN