Provider Demographics
NPI:1588654800
Name:BALASUBRAMANIAM, NADARAJAH (MD)
Entity Type:Individual
Prefix:MR
First Name:NADARAJAH
Middle Name:
Last Name:BALASUBRAMANIAM
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 1:4567 CROSSRAODS PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:211 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SARATOGO SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2661
Practice Address - Country:US
Practice Address - Phone:518-583-8442
Practice Address - Fax:315-295-2125
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129630207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E41076Medicare UPIN