=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235104803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LALU GEORGE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2006
-----------------------------------------------------
Last Update Date | 03/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 451 CLARKSON AVENUE KINGS COUNTY HOSPITAL
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-245-3612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 BUCHANAN AVENUE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-983-1118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 189497
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------