Provider Demographics
NPI:1922350958
Name:NALAM, SAILAJA
Entity Type:Individual
Prefix:
First Name:SAILAJA
Middle Name:
Last Name:NALAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WINDING WOOD DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2756
Mailing Address - Country:US
Mailing Address - Phone:908-917-8310
Mailing Address - Fax:
Practice Address - Street 1:702 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2613
Practice Address - Country:US
Practice Address - Phone:718-834-6368
Practice Address - Fax:718-330-2503
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057493183500000X
NJ28RI03523800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist