Basic Information
| Provider Information | |||||||||
| NPI: | 1295716173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | WAN | ||||||||
| MiddleName: | LING | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 E 42ND ST FL 9 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100175699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466058188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16TH ST AT 1ST AVE | ||||||||
| Address2: | BIMC DEPT OF GENERAL MEDICINE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124204145 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 211380 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 211380 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 01911559 | 05 | NY | MEDICAID |