Individual provider Active NPI

Samuel Lam, PT, DPT

  • Physical Therapist
  • Long Island City, NY
National Provider Identifier
1417872201
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
053351 Issued in NY
Practice address
4502 Queens Blvd
Long Island City, NY 11104-2304
Phone
(347) 812-0455
Fax
(212) 784-6871
NPI assigned
Aug 11, 2026
Sex
Unspecified or another gender identity
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 053351 NY Primary

Addresses

Primary practice location

4502 Queens Blvd
Long Island City, NY 11104-2304

Mailing address

102 Madison Avenue, 8TH FL
New York, NY 10016-6575
Phone (212) 759-2282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1786406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1417872201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 MADISON AVENUE, 8TH FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166575",
            "telephone_number": "212-759-2282",
            "fax_number": "212-379-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 QUEENS BLVD",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111042304",
            "telephone_number": "347-812-0455",
            "fax_number": "212-784-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAM",
        "first_name": "SAMUEL",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2026-08-11",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "053351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.