Provider Demographics
NPI:1982002010
Name:TAM, JENNIFER BIK KI (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BIK KI
Last Name:TAM
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MORTON STREET
Mailing Address - Street 2:APT 9EW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-7803
Mailing Address - Country:US
Mailing Address - Phone:917-609-8633
Mailing Address - Fax:646-638-3862
Practice Address - Street 1:100 MORTON STREET
Practice Address - Street 2:APT 9EW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-7803
Practice Address - Country:US
Practice Address - Phone:917-609-8633
Practice Address - Fax:646-638-3862
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical