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General NPI Number Information
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NPI Number | 1619053071
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Entity Type | Organization
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Legal Business Name | PROCARE MEDICAL SERVICES PC
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Dates
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Enumeration Date | 10/28/2006
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 13630 MAPLE AVE SUITE 2L
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City | FLUSHING
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State | NY
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Zip | 11355-3868
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Country | US
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Telephone | 718-888-9202
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Fax | 718-888-9204
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Provider Business Mailing Address
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Address Line | 13630 MAPLE AVE SUITE 2L
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City | FLUSHING
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State | NY
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Zip | 11355-3868
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Country | US
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Telephone | 718-888-9202
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Fax | 718-888-9204
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Authorized Official
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Title or Position | PRESIDENT
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Name | WAI-KUEN LAM
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Credential | M.D.
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Telephone | 718-888-9202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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