Active NPI
Linda Loretta Lally
- General Practice Physician
- Staten Island, NY
National Provider Identifier
1184184004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 370379
- Practice address
- 69 Stack Dr
Staten Island, NY 10312-1662 - Phone
- (347) 598-6171
- NPI assigned
- Mar 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 370379 | NY | Primary |
Addresses
Primary practice location
69 Stack Dr
Staten Island, NY 10312-1662
Mailing address
69 Stack Dr
Staten Island, NY 10312-1662
Phone (347) 598-6171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 370379 | NY | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553472000000",
"number": "1184184004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "69 STACK DR",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103121662",
"telephone_number": "347-598-6171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "69 STACK DR",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103121662",
"telephone_number": "347-598-6171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LALLY",
"first_name": "LINDA",
"middle_name": "LORETTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-25",
"last_updated": "2019-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NY",
"license": "370379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.