Provider Demographics
NPI:1093777534
Name:VASAVADA, BALENDU (MD)
Entity Type:Individual
Prefix:
First Name:BALENDU
Middle Name:
Last Name:VASAVADA
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 1:300 CADMAN PLAZA WEST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:929-210-6000
Mailing Address - Fax:929-210-6001
Practice Address - Street 1:300 CADMAN PLAZA WEST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:929-210-6000
Practice Address - Fax:929-210-6001
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133619207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00867794Medicaid
B10732Medicare UPIN
NYA400092449Medicare PIN