Provider Demographics
NPI:1649434333
Name:BALAKRISHNAN, VIJAY BABU (MD, CCD)
Entity type:Individual
Prefix:DR
First Name:VIJAY BABU
Middle Name:
Last Name:BALAKRISHNAN
Suffix:
Gender:M
Credentials:MD, CCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E. NEW YORK AVE
Mailing Address - Street 2:4TH FLOOR ADMIN
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2136
Mailing Address - Country:US
Mailing Address - Phone:609-653-3265
Mailing Address - Fax:609-926-4311
Practice Address - Street 1:18 W NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1872
Practice Address - Country:US
Practice Address - Phone:609-365-5300
Practice Address - Fax:609-365-5302
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09484400207RE0101X
PAMT192092207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0440710Medicaid