Basic Information
| Provider Information | |||||||||
| NPI: | 1801952981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALAM | ||||||||
| FirstName: | LOBINA | ||||||||
| MiddleName: | KANIZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WATER ST | ||||||||
| Address2: | FL 12 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100410004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666338255 | ||||||||
| FaxNumber: | 9292633957 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 WATERS PL | ||||||||
| Address2: | TOWER 2 11TH FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666338255 | ||||||||
| FaxNumber: | 9292633957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2006 | ||||||||
| LastUpdateDate: | 12/28/2017 | ||||||||
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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 | 230905 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2828715 | 05 | NY | MEDICAID |