Provider Demographics
NPI:1730421868
Name:BALIDEMAJ, EMIRA
Entity type:Individual
Prefix:
First Name:EMIRA
Middle Name:
Last Name:BALIDEMAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5002
Mailing Address - Country:US
Mailing Address - Phone:718-828-3222
Mailing Address - Fax:718-828-3222
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7400
Practice Address - Country:US
Practice Address - Phone:631-659-3337
Practice Address - Fax:631-659-3338
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist