| Kanchana Bala Md Llc | |
|
6 Walter Ct Rutherford NJ 07070-2558 | |
| (201) 893-2939 | |
| (201) 460-0770 |
| Full Name | Kanchana Bala Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6 Walter Ct, Rutherford, New Jersey |
| Authorized Official Name and Position | Kanchana Balasubramanian (PRESIDENT) |
| Authorized Official Contact | 2018932939 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kanchana Bala Md Llc 6 Walter Ct Rutherford NJ 07070-2558 Ph: (201) 893-2939 | Kanchana Bala Md Llc 6 Walter Ct Rutherford NJ 07070-2558 Ph: (201) 893-2939 |
| NPI Number | 1952442329 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 01/20/2011 |
| Medicare PECOS PAC ID | 3870589641 |
|---|---|
| Medicare Enrollment ID | O20040426000586 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952442329 | NPI | - | NPPES |
| 0016497 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA07605600 (New Jersey) | Primary |
| Provider Name | Kanchana Balasubramanian |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1780626143 PECOS PAC ID: 6406842251 Enrollment ID: I20040426000495 |
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