Provider Demographics
NPI:1891074902
Name:LAM QUAN, M.D., P.C.
Entity Type:Organization
Organization Name:LAM QUAN, M.D., P.C.
Other - Org Name:QUANTUM MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAM
Authorized Official - Middle Name:CU
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-670-3530
Mailing Address - Street 1:27 SUNNYSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1510
Mailing Address - Country:US
Mailing Address - Phone:917-670-3530
Mailing Address - Fax:516-576-0691
Practice Address - Street 1:1302 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1418
Practice Address - Country:US
Practice Address - Phone:516-223-7533
Practice Address - Fax:516-223-7534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-06
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA241419261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02892455Medicaid