Provider Demographics
NPI:1558366740
Name:BALAGHI, MESBAHEDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MESBAHEDDIN
Middle Name:
Last Name:BALAGHI
Suffix:
Gender:M
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:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-0152
Mailing Address - Country:US
Mailing Address - Phone:845-831-0479
Mailing Address - Fax:845-831-0631
Practice Address - Street 1:831 ROUTE 52
Practice Address - Street 2:STE L2
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1563
Practice Address - Country:US
Practice Address - Phone:845-831-0479
Practice Address - Fax:845-831-0631
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01672797Medicaid
NY01672797Medicaid
NYWEN881Medicare ID - Type Unspecified