Provider Demographics
NPI:1669968194
Name:KULAKKUZHIYIL BALAN, PRATHIBHA
Entity type:Individual
Prefix:
First Name:PRATHIBHA
Middle Name:
Last Name:KULAKKUZHIYIL BALAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22N READING RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2184
Mailing Address - Country:US
Mailing Address - Phone:952-495-4196
Mailing Address - Fax:
Practice Address - Street 1:1503 FINNEGAN LN
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1061
Practice Address - Country:US
Practice Address - Phone:732-658-6070
Practice Address - Fax:888-828-3316
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01280800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist