Provider Demographics
NPI:1649608951
Name:LAM, FUNG
Entity type:Individual
Prefix:
First Name:FUNG
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:511 W 157TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7601
Practice Address - Country:US
Practice Address - Phone:212-781-7979
Practice Address - Fax:212-781-7963
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY582465163WE0003X
NY306582363LA2200X
NYF340629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331945Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
NY00695941Medicaid
WI331946Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
NY331957Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
NY571000Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification