Provider Demographics
NPI:1366536682
Name:BOTROS, LAMIA KAMEL (MD)
Entity type:Individual
Prefix:
First Name:LAMIA
Middle Name:KAMEL
Last Name:BOTROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3108
Mailing Address - Country:US
Mailing Address - Phone:845-358-1677
Mailing Address - Fax:845-358-3640
Practice Address - Street 1:18 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3108
Practice Address - Country:US
Practice Address - Phone:845-358-1677
Practice Address - Fax:845-358-3640
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2142242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H25986Medicare UPIN
062860Medicare PIN