Provider Demographics
NPI:1093266801
Name:BALA, FATIMA HAMZA
Entity Type:Individual
Prefix:
First Name:FATIMA HAMZA
Middle Name:
Last Name:BALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ALEXANDER AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4228
Mailing Address - Country:US
Mailing Address - Phone:914-433-9064
Mailing Address - Fax:
Practice Address - Street 1:85 EXECUTIVE BLVD UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1326
Practice Address - Country:US
Practice Address - Phone:914-347-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66PO3958225200000X
NY013919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant