Provider Demographics
NPI:1316124217
Name:LAO, MONA LISA ONG (PT)
Entity type:Individual
Prefix:
First Name:MONA LISA
Middle Name:ONG
Last Name:LAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4869
Mailing Address - Country:US
Mailing Address - Phone:201-936-2660
Mailing Address - Fax:201-299-3506
Practice Address - Street 1:277 VIRGINIA AVE 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1454
Practice Address - Country:US
Practice Address - Phone:201-936-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01062100225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ154799Medicare PIN