Provider Demographics
NPI:1184747073
Name:LAM, KANEI (PHD)
Entity type:Individual
Prefix:DR
First Name:KANEI
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KA
Other - Middle Name:NEI
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0099
Mailing Address - Country:US
Mailing Address - Phone:212-490-3590
Mailing Address - Fax:
Practice Address - Street 1:211 E 43RD ST
Practice Address - Street 2:SUITE 1901
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:212-490-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3608857OtherOXFORD
NY7817787OtherAETNA
NY368626OtherMHN
NY02634655Medicaid
NY02634655Medicaid