1538205968 NPI number — ANNMARIE M LALLY F-NP

Table of content: ANNMARIE M LALLY F-NP (NPI 1538205968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538205968 NPI number — ANNMARIE M LALLY F-NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LALLY
Provider First Name:
ANNMARIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F-NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538205968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9150 THOMPSONWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARENCE CENTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14032-9775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-741-3137
Provider Business Mailing Address Fax Number:
716-741-3137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 NIAGARA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14150-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-743-5450
Provider Business Practice Location Address Fax Number:
716-743-5455
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F332056-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000560375001 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9512250 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: B4744 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com