Provider Demographics
NPI:1295851699
Name:AHLUWALIA, MADHU BALA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:BALA
Last Name:AHLUWALIA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11 MEDICAL PARK DR
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3559
Mailing Address - Country:US
Mailing Address - Phone:845-362-2115
Mailing Address - Fax:845-362-2102
Practice Address - Street 1:11 MEDICAL PARK DR
Practice Address - Street 2:SUITE # 106
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3559
Practice Address - Country:US
Practice Address - Phone:845-362-2115
Practice Address - Fax:845-362-2102
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1360522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98A401Medicare ID - Type Unspecified