Provider Demographics
NPI:1952414815
Name:BALAESCU, MIHAELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIHAELA
Middle Name:
Last Name:BALAESCU
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 1:4701 QUEENS BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1606
Mailing Address - Country:US
Mailing Address - Phone:718-784-7500
Mailing Address - Fax:718-361-1130
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1600
Practice Address - Country:US
Practice Address - Phone:718-784-7500
Practice Address - Fax:646-967-4035
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02088764Medicaid
NYH11953Medicare UPIN
NY04279Medicare PIN