Basic Information
Provider Information
NPI: 1003012410
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TINDOC
FirstName: LORELANE
MiddleName: PAGULAYAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: PAGULAYAN
OtherFirstName: LORELANE
OtherMiddleName:  
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: 780 ALLWOOD RD
Address2:  
City: CLIFTON
State: NJ
PostalCode: 070121923
CountryCode: US
TelephoneNumber: 9732496202
FaxNumber: 9732496203
Practice Location
Address1: 780 ALLWOOD RD
Address2:  
City: CLIFTON
State: NJ
PostalCode: 070121923
CountryCode: US
TelephoneNumber: 9732496202
FaxNumber: 9732496203
Other Information
ProviderEnumerationDate: 06/22/2007
LastUpdateDate: 07/06/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X25MA0883500NJN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X048737CTY Allopathic & Osteopathic PhysiciansFamily Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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