Provider Demographics
NPI:1912296278
Name:'DUNDEVA-BALEV',LLC
Entity Type:Organization
Organization Name:'DUNDEVA-BALEV',LLC
Other - Org Name:EWING RHEUMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:MD/SINGLE MEMBER LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVLINKA
Authorized Official - Middle Name:VANYOVA
Authorized Official - Last Name:DUNDEVA-BALEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-883-1171
Mailing Address - Street 1:14 MILLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3630
Mailing Address - Country:US
Mailing Address - Phone:609-883-1211
Mailing Address - Fax:609-883-7777
Practice Address - Street 1:1901 N OLDEN AVENUE EXT
Practice Address - Street 2:SUITE 13A
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2111
Practice Address - Country:US
Practice Address - Phone:609-883-1171
Practice Address - Fax:609-883-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08452900207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty