Provider Demographics
NPI:1407946601
Name:LAM, TIMOTHY GARY (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GARY
Last Name:LAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6113
Mailing Address - Country:US
Mailing Address - Phone:518-370-3668
Mailing Address - Fax:518-370-7162
Practice Address - Street 1:1610 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6113
Practice Address - Country:US
Practice Address - Phone:518-370-3668
Practice Address - Fax:518-370-7162
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005232213EP0504X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01619667Medicaid
NYU59439OtherUPIN
NY5429300001Medicare NSC
NYBA0582Medicare PIN
NYBA0582Medicare ID - Type Unspecified
NY01619667Medicaid