Provider Demographics
NPI:1548362759
Name:BALWANI, MANISHA C (MD, MS)
Entity type:Individual
Prefix:
First Name:MANISHA
Middle Name:C
Last Name:BALWANI
Suffix:
Gender:F
Credentials:MD, MS
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE GUSTAVE L. LEVY PLACE
Mailing Address - Street 2:BOX 1497, DEPARTMENT OF HUMAN GENETICS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-241-0915
Mailing Address - Fax:212-426-9065
Practice Address - Street 1:1184 FIFTH AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-0915
Practice Address - Fax:212-426-9065
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002709207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02811205Medicaid
NY02811205Medicaid