Provider Demographics
NPI:1306822101
Name:BALDERACCHI, JASMINKA (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMINKA
Middle Name:
Last Name:BALDERACCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TENTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-523-8627
Mailing Address - Fax:212-523-7232
Practice Address - Street 1:FIRST AVE AT 16TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:516-542-1090
Practice Address - Fax:516-794-8165
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225078207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55R691Medicare ID - Type UnspecifiedMEDICARE #
NYH99757Medicare UPIN