Provider Demographics
NPI:1053867648
Name:LAL, PURUSHOTTAM
Entity Type:Individual
Prefix:
First Name:PURUSHOTTAM
Middle Name:
Last Name:LAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LENOX RD
Mailing Address - Street 2:APT# 4H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2273
Mailing Address - Country:US
Mailing Address - Phone:646-867-5350
Mailing Address - Fax:
Practice Address - Street 1:300 LENOX RD
Practice Address - Street 2:APT#4H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2273
Practice Address - Country:US
Practice Address - Phone:646-867-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program