Provider Demographics
NPI:1346978848
Name:LALL MEDICAL, LLC
Entity Type:Organization
Organization Name:LALL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-206-1501
Mailing Address - Street 1:725 ORCHARD PARK RD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3352
Mailing Address - Country:US
Mailing Address - Phone:716-675-1001
Mailing Address - Fax:716-675-3832
Practice Address - Street 1:725 ORCHARD PARK RD STE A
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3352
Practice Address - Country:US
Practice Address - Phone:716-675-1001
Practice Address - Fax:716-675-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty