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NPI Code Detail

MEDICARE: DR. SANJAY LALLA M. D.

MEDICARE:  DR. SANJAY  LALLA  M. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery PhysicianMA58573NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295797256
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANJAY LALLA M. D.
Provider Business Mailing Address
First Line : 383 NORTHFIELD AVE
Second Line :
City : WEST ORANGE
State : NJ
Zip : 07052-3024
Country : US
Telephone Number : 973-324-9455
Fax Number : 973-324-9454
Provider Business Practice Location Address
First Line : 383 NORTHFIELD AVE
Second Line :
City : WEST ORANGE
State : NJ
Zip : 07052-3024
Country : US
Telephone Number : 973-324-9455
Fax Number : 973-324-9454
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 03/03/2008

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Directions to “ DR. SANJAY LALLA M. D.” Practice Location

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