Most Relevant Information
Provider Data
| NPI Number: | 1003525395 |
| Provider Name: | ANSELM LALLA RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163WC1600X |
| Specialty: | Registered Nurse |
| License Number: | 684194 |
Most Important Dates
| Enumeration Date: | 11/16/2022 |
| Last Updated: | 11/16/2022 |
Provider Practice Location
1516 ORIENTAL BLVD
BROOKLYN
NY
112352328
Practice Location Phone/Fax
| Phone: | 7186464441 |
| Fax: |
Provider Mailing Location
2775 E 16TH ST APT 6F
BROOKLYN
NY
112354060
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |