Provider Demographics
NPI:1841414216
Name:BALMIR, SERGE JR (DO)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:BALMIR
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 KINGS HWY
Mailing Address - Street 2:SUITE C4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2644
Mailing Address - Country:US
Mailing Address - Phone:718-338-2283
Mailing Address - Fax:718-253-2204
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:SUITE C4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:718-338-2283
Practice Address - Fax:718-253-2204
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232339207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591995Medicaid
NYI19387Medicare UPIN