Provider Demographics
NPI:1730191636
Name:NULI, BALAKRISHNA (MD)
Entity type:Individual
Prefix:
First Name:BALAKRISHNA
Middle Name:
Last Name:NULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RODEO DRIVE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:917-374-7004
Mailing Address - Fax:718-250-8931
Practice Address - Street 1:240 WILLOUAHBY ST
Practice Address - Street 2:SUITE 11E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:718-250-8866
Practice Address - Fax:718-250-6703
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113659208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00207070Medicaid
B17698Medicare UPIN
NY00207070Medicaid