Provider Demographics
NPI:1033154380
Name:BALAKUMAR, DORAIKANNU (MD)
Entity Type:Individual
Prefix:DR
First Name:DORAIKANNU
Middle Name:
Last Name:BALAKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX A
Mailing Address - Street 2:ASSURE ANESTHESIA
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-0745
Mailing Address - Country:US
Mailing Address - Phone:800-720-1664
Mailing Address - Fax:207-753-2020
Practice Address - Street 1:2475 SAINT RAYMONDS AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-430-7473
Practice Address - Fax:718-430-7336
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03728600207L00000X
NY140588207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00154666OtherRAILROAD MEDICARE
NY00708503Medicaid
NY00708503Medicaid
P00154666OtherRAILROAD MEDICARE