Provider Demographics
NPI:1821212887
Name:WAGLE, LALITA (MD)
Entity Type:Individual
Prefix:
First Name:LALITA
Middle Name:
Last Name:WAGLE
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 1:811 GOLF PL
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1215
Mailing Address - Country:US
Mailing Address - Phone:201-262-6522
Mailing Address - Fax:201-833-7073
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:HOLY NAME HOSPITAL
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-541-5989
Practice Address - Fax:201-833-7073
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ61069Medicare UPIN