Provider Demographics
NPI:1073506937
Name:LAMPERT, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:LAMPERT
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 1:149 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6103
Mailing Address - Country:US
Mailing Address - Phone:718-855-0909
Mailing Address - Fax:
Practice Address - Street 1:149 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6103
Practice Address - Country:US
Practice Address - Phone:718-855-0909
Practice Address - Fax:718-522-2211
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142914207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00811849Medicaid
140791Medicare ID - Type Unspecified
NY00811849Medicaid