Individual
MR. DERRICK TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
622 W 168TH ST PH 5-505, NEW YORK, NY 10032-3720
(347) 466-3566
Mailing address
9 COMSTOCK AVE, STATEN ISLAND, NY 10314-1404
(347) 466-3566
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
705883
NY
363LA2100X
Acute Care Nurse Practitioner
Primary
F432636-01
NY
Other
Enumeration date
02/07/2016
Last updated
01/23/2024
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