Provider Demographics
NPI:1972779098
Name:BALANI, ANIL R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:R
Last Name:BALANI
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 1:2 CAPITAL WAY STE 456
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2521
Mailing Address - Country:US
Mailing Address - Phone:609-537-5000
Mailing Address - Fax:609-537-5050
Practice Address - Street 1:2 CAPITAL WAY STE 380
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-537-5000
Practice Address - Fax:609-537-5050
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236993207RG0100X
PAMD434248207RG0100X
NJ25MA08408000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00855787OtherRR MCR PTAN
NJ0169781Medicaid
NJ128801B89Medicare PIN
NJP00855787OtherRR MCR PTAN