Provider Demographics
NPI:1609861186
Name:LAM, PAUL C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:LAM
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 1:16 POCONO RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2901
Mailing Address - Country:US
Mailing Address - Phone:973-625-1666
Mailing Address - Fax:973-625-1769
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-625-1666
Practice Address - Fax:973-625-1769
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04047700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE74857Medicare UPIN
NJ022468Medicare ID - Type Unspecified