Provider Demographics
NPI:1265452189
Name:WALIA, BIRENDRA SINGH (MD)
Entity Type:Individual
Prefix:
First Name:BIRENDRA
Middle Name:SINGH
Last Name:WALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BIRENDRA
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 416173
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6173
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M115
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-0370
Practice Address - Country:US
Practice Address - Phone:718-794-9729
Practice Address - Fax:718-794-9730
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241963-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0187593Medicaid
NY02479087Medicaid
NY7X4541Medicare PIN
NY02479087Medicaid
NJ153783VBMMedicare PIN