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General NPI Number Information
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NPI Number | 1992460547
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Entity Type | Individual
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Provider Name | NICHOLAS LOUIS LAMB PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 438 GANTTOWN RD STE B8-B9
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City | SEWELL
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State | NJ
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Zip | 08080-2341
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Country | US
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Telephone | 856-344-7916
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Fax | 856-344-7920
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Provider Business Mailing Address
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Address Line | 89 CHESTNUT AVE
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City | HADDON TOWNSHIP
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State | NJ
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Zip | 08108-3406
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Country | US
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Telephone | 215-275-3558
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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 | 25MP00660500
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License Number State | NJ
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