Provider Demographics
NPI:1093766578
Name:LALIA, MADELINE ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:ROSE
Last Name:LALIA
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 1:1436 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1405
Mailing Address - Country:US
Mailing Address - Phone:929-210-6550
Mailing Address - Fax:
Practice Address - Street 1:1436 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1405
Practice Address - Country:US
Practice Address - Phone:929-210-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE44691Medicare UPIN
NYE44691Medicare UPIN