Provider Demographics
NPI:1265557151
Name:JOSEPH P. LALKA MD PC
Entity type:Organization
Organization Name:JOSEPH P. LALKA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:LALKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-392-1122
Mailing Address - Street 1:1556 STATE ROUTE 203
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-1708
Mailing Address - Country:US
Mailing Address - Phone:518-392-2499
Mailing Address - Fax:
Practice Address - Street 1:29 JONES AVE
Practice Address - Street 2:CHATHAM MEDICAL BUILDING
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1136
Practice Address - Country:US
Practice Address - Phone:518-392-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47307207Q00000X
NY139020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00716174Medicaid
NYBA0728Medicare PIN
NY71A951Medicare PIN
B18905Medicare UPIN
NY00716174Medicaid