Healthcare Provider Details

I. General information

NPI: 1407946601
Provider Name (Legal Business Name): TIMOTHY GARY LAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 UNION ST
SCHENECTADY NY
12309-6113
US

IV. Provider business mailing address

1610 UNION ST
SCHENECTADY NY
12309-6113
US

V. Phone/Fax

Practice location:
  • Phone: 518-370-3668
  • Fax: 518-370-7162
Mailing address:
  • Phone: 518-370-3668
  • Fax: 518-370-7162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberN005232
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN005232
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005232
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01619667
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
IdentifierU59439
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUPIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: