Healthcare Provider Details

I. General information

NPI: 1417872201
Provider Name (Legal Business Name): SAMUEL LAM PT, DPT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 QUEENS BLVD
LONG ISLAND CITY NY
11104-2304
US

IV. Provider business mailing address

102 MADISON AVENUE, 8TH FL
NEW YORK NY
10016-6575
US

V. Phone/Fax

Practice location:
  • Phone: 347-812-0455
  • Fax: 212-784-6871
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number053351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: