Provider Demographics
NPI:1578765863
Name:BALAJI, MINI (MD)
Entity Type:Individual
Prefix:DR
First Name:MINI
Middle Name:
Last Name:BALAJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MINI
Other - Middle Name:
Other - Last Name:RADHA PODIYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:12 BERNADETTE CIR
Mailing Address - Street 2:MONMOUTH JUNCTION
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 W BLACKWELL ST
Practice Address - Street 2:VITAL MEDICAL FORCES
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2525
Practice Address - Country:US
Practice Address - Phone:973-989-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08316100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine