Provider Demographics
NPI:1144227976
Name:KAM, BOB (MD)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:
Last Name:KAM
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 1:117 E 57TH ST
Mailing Address - Street 2:36 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2002
Mailing Address - Country:US
Mailing Address - Phone:212-751-4651
Mailing Address - Fax:212-751-4651
Practice Address - Street 1:117 E 57TH ST
Practice Address - Street 2:36 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2002
Practice Address - Country:US
Practice Address - Phone:212-751-4651
Practice Address - Fax:212-751-4651
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA75669174400000X
NY225713207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0000469Medicaid
NJH84299Medicare UPIN
NJ069807Medicare ID - Type Unspecified