Provider Demographics
NPI:1609913102
Name:LALLA, SAPNA S (RD)
Entity Type:Individual
Prefix:MRS
First Name:SAPNA
Middle Name:S
Last Name:LALLA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2222
Mailing Address - Country:US
Mailing Address - Phone:917-589-6522
Mailing Address - Fax:
Practice Address - Street 1:11 GARDEN PL
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2222
Practice Address - Country:US
Practice Address - Phone:917-589-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1609913102Medicare PIN