Provider Demographics
NPI:1760843072
Name:BALA, ANJU (PT)
Entity Type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:BALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SIENNA WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-3614
Mailing Address - Country:US
Mailing Address - Phone:201-820-4132
Mailing Address - Fax:
Practice Address - Street 1:8 SIENNA WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-3614
Practice Address - Country:US
Practice Address - Phone:201-820-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist