Healthcare Provider Details

I. General information

NPI: 1982661971
Provider Name (Legal Business Name): SUMAN LATA JALAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 POWERVILLE RD
BOONTON NJ
07005-8705
US

IV. Provider business mailing address

17 IRONWOOD DR
MORRIS PLAINS NJ
07950-3326
US

V. Phone/Fax

Practice location:
  • Phone: 973-299-5463
  • Fax:
Mailing address:
  • Phone: 973-299-5463
  • Fax: 973-971-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA03995800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: