Provider Demographics
NPI:1063042737
Name:LALL, CHANDRA
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:LALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3966 ORLOFF AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2803
Mailing Address - Country:US
Mailing Address - Phone:646-354-3746
Mailing Address - Fax:
Practice Address - Street 1:305 W 44TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-5407
Practice Address - Country:US
Practice Address - Phone:212-586-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY531974163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care