Juanita O Lao Md Pc | |
333 Lafayette Ave Suite Pb Brooklyn NY 11238-1350 | |
(718) 789-1116 | |
Not Available |
Full Name | Juanita O Lao Md Pc |
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Speciality | Clinic/Center |
Location | 333 Lafayette Ave, Brooklyn, New York |
Authorized Official Name and Position | Juanita Ong Lao (DIRECT OWNER) |
Authorized Official Contact | 7187891116 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Juanita O Lao Md Pc 121 De Kalb Ave. Brooklyn NY 11201-5425 Ph: (718) 789-1116 | Juanita O Lao Md Pc 333 Lafayette Ave Suite Pb Brooklyn NY 11238-1350 Ph: (718) 789-1116 |
NPI Number | 1144511908 |
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Provider Enumeration Date | 04/28/2011 |
Last Update Date | 04/28/2011 |
Medicare PECOS PAC ID | 3173709540 |
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Medicare Enrollment ID | O20110519000305 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144511908 | NPI | - | NPPES |
00211918 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 115220 (New York) | Primary |
Provider Name | Juanita O Lao |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1760568943 PECOS PAC ID: 1951587328 Enrollment ID: I20110519000351 |
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