Provider Demographics
NPI:1003857392
Name:LAM, PATRICK KI-CHEONG (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KI-CHEONG
Last Name:LAM
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 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4300
Mailing Address - Fax:
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4652
Practice Address - Country:US
Practice Address - Phone:845-334-2890
Practice Address - Fax:845-334-2816
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132757-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01976961Medicaid
C87542Medicare UPIN
NY01976961Medicaid