Provider Demographics
NPI:1760427793
Name:BALAKRISHNAN, KUMARANAYAGAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMARANAYAGAM
Middle Name:
Last Name:BALAKRISHNAN
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 1:197 CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3328
Mailing Address - Country:US
Mailing Address - Phone:718-616-3472
Mailing Address - Fax:718-616-3049
Practice Address - Street 1:121 DEKALB AVENUE
Practice Address - Street 2:BROOKLYN HOSPITAL CENTER , 2ND FLOOR, PATHOLGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-250-8216
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA117310207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00652777Medicaid
NY00652777Medicaid
NY84A73Medicare ID - Type Unspecified