1992028542 NPI number — DR. MAYA BALAKRISHNAN PURI MD

Table of content: MADISON SITTON (NPI 1073376745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992028542 NPI number — DR. MAYA BALAKRISHNAN PURI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURI
Provider First Name:
MAYA
Provider Middle Name:
BALAKRISHNAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALAKRISHNAN
Provider Other First Name:
MAYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992028542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 JOHN ST
Provider Second Line Business Mailing Address:
APT 814
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10038-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-277-4455
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 JOHN ST
Provider Second Line Business Practice Location Address:
APT 814
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10038-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-277-4455
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  253335 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 253335-1 . This is a "LICENSE#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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