Provider Demographics
NPI:1437974573
Name:ADALLA, LALLUH ADREN RENON
Entity type:Individual
Prefix:
First Name:LALLUH ADREN
Middle Name:RENON
Last Name:ADALLA
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 1:14725 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3480
Mailing Address - Country:US
Mailing Address - Phone:917-383-7306
Mailing Address - Fax:
Practice Address - Street 1:14725 88TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3480
Practice Address - Country:US
Practice Address - Phone:917-383-7306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist