MEDICARE: CONNIE LAM D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	248891	NY

General Provider Information

NPI Number	:	1174717920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE LAM D.O

Provider Business Mailing Address
First Line	:	2431 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4448
Country	:	US
Telephone Number	:	718-513-6503
Fax Number	:	718-513-6504

Provider Business Practice Location Address
First Line	:	2431 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4448
Country	:	US
Telephone Number	:	718-513-6503
Fax Number	:	718-513-6504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	10/08/2013

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Directions to “ CONNIE LAM D.O” Practice Location

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