Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 195464 | NY |
NPI | 1356410914 |
---|---|
Provider Name | Dr. Thomas Anthony Lallas |
First Address | New York, NY 10021-4156 |
Second Address | New York, NY 10021-4156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G97603 | (02) |