Basic Information
| Provider Information | |||||||||
| NPI: | 1689977332 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHIA-LUNG LAI MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 116 | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070100116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006240792 | ||||||||
| FaxNumber: | 2019438105 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 WESCOTT DR | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088224603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087886100 | ||||||||
| FaxNumber: | 9087886145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2010 | ||||||||
| LastUpdateDate: | 12/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | LAI | ||||||||
| AuthorizedOfficialFirstName: | CHIA-LUNG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9087354681 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA03085000 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0839400 | 05 | NJ | MEDICAID |