Provider Demographics
NPI:1679550370
Name:LALL, KAILASH C (MD)
Entity Type:Individual
Prefix:DR
First Name:KAILASH
Middle Name:C
Last Name:LALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ORCHARD PARK RD
Mailing Address - Street 2:SUITE A
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
Practice Address - Street 2:SUITE A
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138935204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00637458Medicaid
NYB71664Medicare UPIN