Provider Demographics
NPI:1356508642
Name:LAM, ANN (RPT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 89TH AVE
Mailing Address - Street 2:APT. #2
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2262
Mailing Address - Country:US
Mailing Address - Phone:212-539-0257
Mailing Address - Fax:212-677-4853
Practice Address - Street 1:460 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4058
Practice Address - Country:US
Practice Address - Phone:212-539-0257
Practice Address - Fax:212-677-4853
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist