Active NPI
Rogelio S Lao, MD
- Pediatrics Physician
- Riverhead, NY
National Provider Identifier
1386682565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 103078
- Practice address
- 34 Commerce Ave
Suite 2
Riverhead, NY 11901-3118 - Phone
- (631) 722-8880
- Fax
- (631) 722-7851
- NPI assigned
- Jun 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 103078 | NY | Primary |
Addresses
Primary practice location
34 Commerce Ave
Suite 2
Riverhead, NY 11901-3118
Mailing address
68 S Service Rd
Suite 350
Melville, NY 11747-2354
Phone (516) 945-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00649243 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103078 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351209600000",
"number": "1386682565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 S SERVICE RD",
"address_2": "SUITE 350",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117472354",
"telephone_number": "516-945-3000",
"fax_number": "516-945-3131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 COMMERCE AVE",
"address_2": "SUITE 2",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119013118",
"telephone_number": "631-722-8880",
"fax_number": "631-722-7851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAO",
"first_name": "ROGELIO",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2012-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "103078",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00649243",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Riverhead, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.