Healthcare Provider Details

I. General information

NPI: 1740292838
Provider Name (Legal Business Name): JOSEPH P. LALKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 JEFFERSON HTS, GMA SUITE A102 CATSKILL VA PRIMARY CARE
CATSKILL NY
12414-1204
US

IV. Provider business mailing address

159 JEFFERSON HTS, GMA SUITE A102 CATSKILL VA PRIMARY CARE
CATSKILL NY
12414-1204
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5240
  • Fax: 518-943-7289
Mailing address:
  • Phone: 518-626-5240
  • Fax: 518-943-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number139020
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47307
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: