Provider Demographics
NPI:1194782706
Name:LAL, INDU M (MD)
Entity type:Individual
Prefix:
First Name:INDU
Middle Name:M
Last Name:LAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INDU
Other - Middle Name:M
Other - Last Name:LAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6122
Mailing Address - Country:US
Mailing Address - Phone:845-221-2707
Mailing Address - Fax:845-227-4642
Practice Address - Street 1:4 FOSTER RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-6122
Practice Address - Country:US
Practice Address - Phone:845-221-2707
Practice Address - Fax:845-227-4642
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA1403371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY587760Medicaid