Provider Demographics
NPI:1144259383
Name:LALA, VINOD R (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:R
Last Name:LALA
Suffix:
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 1:968 RIVER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2237
Mailing Address - Country:US
Mailing Address - Phone:201-224-8328
Mailing Address - Fax:201-224-2405
Practice Address - Street 1:968 RIVER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2237
Practice Address - Country:US
Practice Address - Phone:201-224-8328
Practice Address - Fax:201-224-2405
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37432174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist