Provider Demographics
NPI:1184656050
Name:LAM, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
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 1:52 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1728
Mailing Address - Country:US
Mailing Address - Phone:201-519-8152
Mailing Address - Fax:
Practice Address - Street 1:1565 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6911
Practice Address - Country:US
Practice Address - Phone:201-969-0018
Practice Address - Fax:201-461-0838
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7851405Medicaid
NJG82551Medicare UPIN
NJ021223Medicare ID - Type Unspecified