Provider Demographics
NPI:1578235677
Name:LAM, MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 HILLYER ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4971
Mailing Address - Country:US
Mailing Address - Phone:718-213-5662
Mailing Address - Fax:
Practice Address - Street 1:3310 QUEENS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2302
Practice Address - Country:US
Practice Address - Phone:800-905-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047621208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation