Provider Demographics
NPI:1225035876
Name:LAMPERT, ALAN R (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
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 1:325 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1790
Mailing Address - Country:US
Mailing Address - Phone:631-261-4445
Mailing Address - Fax:631-261-3710
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1790
Practice Address - Country:US
Practice Address - Phone:631-261-4445
Practice Address - Fax:631-261-3710
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27A991OtherMEDICARE LEGACY
CP520OtherOXFORD
0520031OtherAETNA
NY080019015OtherMEDICARE RAILROAD PTAN
1C2591OtherHEALTHNET
NY27A991OtherBLUE CROSS BLUE SHIELD
0018118OtherGHI
NY00533248Medicaid
12999OtherVYTRA
0018118OtherGHI
NY27A991OtherMEDICARE LEGACY