Provider Demographics
NPI:1700521481
Name:BALASUBRAMANIAM, ASVINI (MD)
Entity Type:Individual
Prefix:MS
First Name:ASVINI
Middle Name:
Last Name:BALASUBRAMANIAM
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 1:475 SEAVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-226-9359
Mailing Address - Fax:718-226-3191
Practice Address - Street 1:475 SEAVIEW AVENUE, STATEN ISLAND UNIVERSITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2023-02-21
Deactivation Date:2023-02-08
Deactivation Code:
Reactivation Date:2023-02-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program