Provider Demographics
NPI:1528225513
Name:BALACHANDAR, DIVYA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:BALACHANDAR
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 1:1065 SOUTHERN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459
Mailing Address - Country:US
Mailing Address - Phone:718-589-2440
Mailing Address - Fax:718-893-9018
Practice Address - Street 1:1065 SOUTHERN BOULEVARD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-589-2440
Practice Address - Fax:718-893-9018
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271672208D00000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice