Provider Demographics
NPI:1841805884
Name:LAM, RAYMOND (RD, RDN)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:RD, RDN
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 APT 2F
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:718-710-8827
Mailing Address - Fax:
Practice Address - Street 1:5112 HILLYER ST APT 2F
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4971
Practice Address - Country:US
Practice Address - Phone:718-710-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86167850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered