Provider Demographics
NPI:1508924630
Name:LALLA, P (MD)
Entity Type:Individual
Prefix:MRS
First Name:P
Middle Name:
Last Name:LALLA
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 1:1547 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5341
Mailing Address - Country:US
Mailing Address - Phone:908-687-7101
Mailing Address - Fax:973-669-9691
Practice Address - Street 1:1547 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5341
Practice Address - Country:US
Practice Address - Phone:908-687-7101
Practice Address - Fax:973-669-9691
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ441114Medicare PIN
NJC54512Medicare UPIN