Provider Demographics
NPI:1831387430
Name:M BALAGHI MD PLLC
Entity type:Organization
Organization Name:M BALAGHI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MESBAHEDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-831-0479
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-0152
Mailing Address - Country:US
Mailing Address - Phone:845-831-0479
Mailing Address - Fax:845-831-0631
Practice Address - Street 1:831 ROUTE 52
Practice Address - Street 2:SUITE L2
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1565
Practice Address - Country:US
Practice Address - Phone:845-831-0479
Practice Address - Fax:845-831-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01672797Medicaid
G58758Medicare UPIN
NY01672797Medicaid