Healthcare Provider Details

I. General information

NPI: 1649190190
Provider Name (Legal Business Name): GABRIELLA LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E STATE ST
ITHACA NY
14850-5547
US

IV. Provider business mailing address

57 SCOTCHTOWN AVE
GOSHEN NY
10924-1611
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-3011
  • Fax:
Mailing address:
  • Phone: 845-956-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: