Provider Demographics
NPI:1174717920
Name:LAM, CONNIE (DO)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4448
Mailing Address - Country:US
Mailing Address - Phone:718-513-6503
Mailing Address - Fax:718-513-6504
Practice Address - Street 1:2431 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4448
Practice Address - Country:US
Practice Address - Phone:718-513-6503
Practice Address - Fax:718-513-6504
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics