Provider Demographics
NPI:1578780045
Name:LALLY, JEFFREY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:LALLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W END AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1318
Mailing Address - Country:US
Mailing Address - Phone:973-845-9336
Mailing Address - Fax:
Practice Address - Street 1:124 E 40TH ST
Practice Address - Street 2:SUITE 504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1723
Practice Address - Country:US
Practice Address - Phone:212-867-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008920111N00000X
NJMC05976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor