Provider Demographics
NPI:1275502957
Name:BAL, ASWINE K (MD)
Entity Type:Individual
Prefix:
First Name:ASWINE
Middle Name:K
Last Name:BAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:61 DAVIS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4401
Mailing Address - Country:US
Mailing Address - Phone:732-776-4271
Mailing Address - Fax:732-776-4867
Practice Address - Street 1:61 DAVIS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4401
Practice Address - Country:US
Practice Address - Phone:732-776-4271
Practice Address - Fax:732-776-4867
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2016-12-06
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA054490002080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF03206Medicare UPIN