Provider Demographics
NPI:1740958776
Name:LAM, ANDY T (DC)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:T
Last Name:LAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W BEACH DR
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-7706
Mailing Address - Country:US
Mailing Address - Phone:347-282-3477
Mailing Address - Fax:
Practice Address - Street 1:550 MAMARONECK AVE STE 307
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1615
Practice Address - Country:US
Practice Address - Phone:914-619-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2241111N00000X
NY013616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor