Provider Demographics
NPI:1437392453
Name:BALASUBRAMANIAM, MEERA
Entity Type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:BALASUBRAMANIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RIVER DR S
Mailing Address - Street 2:APARTMENT 1208
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-3798
Mailing Address - Country:US
Mailing Address - Phone:443-668-8012
Mailing Address - Fax:
Practice Address - Street 1:1 PARK AVE
Practice Address - Street 2:NYU BEHAVIORAL HEALTH CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5802
Practice Address - Country:US
Practice Address - Phone:443-668-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2703352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry