Provider Demographics
NPI:1891005922
Name:BALILI, IRIDA (MD)
Entity Type:Individual
Prefix:
First Name:IRIDA
Middle Name:
Last Name:BALILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23-11, 33RD STREET
Mailing Address - Street 2:2A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105
Mailing Address - Country:US
Mailing Address - Phone:215-882-1346
Mailing Address - Fax:
Practice Address - Street 1:2311 33RD ST
Practice Address - Street 2:2A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2460
Practice Address - Country:US
Practice Address - Phone:215-882-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine