Provider Demographics
NPI:1770575821
Name:LALLEMAND, ROGER JR (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:LALLEMAND
Suffix:JR
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 1:59 ROUTE 516
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1416
Mailing Address - Country:US
Mailing Address - Phone:732-613-1000
Mailing Address - Fax:732-613-1092
Practice Address - Street 1:59 ROUTE 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1416
Practice Address - Country:US
Practice Address - Phone:732-613-1000
Practice Address - Fax:732-613-1092
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07185000207XX0005X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine