Provider Demographics
NPI:1316770449
Name:LALL, REHANNA NARESSA
Entity type:Individual
Prefix:
First Name:REHANNA
Middle Name:NARESSA
Last Name:LALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3512
Practice Address - Country:US
Practice Address - Phone:347-484-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist