Provider Demographics
NPI:1619131521
Name:MUBEENA A BALTI MD PC
Entity Type:Organization
Organization Name:MUBEENA A BALTI MD PC
Other - Org Name:MUBEENA A BALTI PHYSICIAN PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUBEENA
Authorized Official - Middle Name:AKHTER
Authorized Official - Last Name:BALTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-836-8380
Mailing Address - Street 1:350 ALBERTA DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1855
Mailing Address - Country:US
Mailing Address - Phone:716-836-8380
Mailing Address - Fax:
Practice Address - Street 1:350 ALBERTA DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1855
Practice Address - Country:US
Practice Address - Phone:716-836-8380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152275207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1514OtherPTAN
NY00751359Medicaid
NYB36178Medicare UPIN