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General NPI Number Information
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NPI Number | 1316284458
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Entity Type | Individual
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Provider Name | GRACE LAM RPAC
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Gender | Female
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 1014 BROOKLYN AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-4003
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Country | US
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Telephone | 718-282-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 E 81ST ST
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City | BROOKLYN
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State | NY
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Zip | 11236-4740
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Country | US
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Telephone | 917-533-2742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010547
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License Number State | NY
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