Provider Demographics
NPI:1972926749
Name:LALL, JONATHAN (LPN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LALL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2607
Mailing Address - Country:US
Mailing Address - Phone:914-308-4246
Mailing Address - Fax:
Practice Address - Street 1:526 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2607
Practice Address - Country:US
Practice Address - Phone:914-308-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317149164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse