Individual
DR. JOHANNA LASALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
240 INDIAN RIVER RD, BLD A STE 1, ORANGE, CT 06477-3649
(203) 795-1664
(203) 795-1665
Mailing address
240 INDIAN RIVER RD, BLD A STE 1, ORANGE, CT 06477-3649
(203) 795-1664
(203) 795-1665
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
035143
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001351436
—
CT
Enumeration date
06/06/2006
Last updated
01/28/2013
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