Provider Demographics
NPI:1558716936
Name:LELLA, ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:LELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1733
Mailing Address - Country:US
Mailing Address - Phone:631-288-7746
Mailing Address - Fax:631-288-7111
Practice Address - Street 1:182 W MONTAUK HWY STE D
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2396
Practice Address - Country:US
Practice Address - Phone:631-287-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine