Provider Demographics
NPI:1326136227
Name:TAM, PHOEBE C (PA)
Entity Type:Individual
Prefix:MS
First Name:PHOEBE
Middle Name:C
Last Name:TAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23-83 BELL BLVD.
Mailing Address - Street 2:DERMATOLOGY CENTER
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360
Mailing Address - Country:US
Mailing Address - Phone:718-423-0200
Mailing Address - Fax:718-423-3134
Practice Address - Street 1:2383 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2053
Practice Address - Country:US
Practice Address - Phone:718-423-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant