1265452189 NPI number — BIRENDRA SINGH WALIA MD

Table of content: BIRENDRA SINGH WALIA MD (NPI 1265452189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265452189 NPI number — BIRENDRA SINGH WALIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALIA
Provider First Name:
BIRENDRA
Provider Middle Name:
SINGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINGH
Provider Other First Name:
BIRENDRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265452189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416173
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-6173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-8900
Provider Business Mailing Address Fax Number:
484-924-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WATERS PL
Provider Second Line Business Practice Location Address:
SUITE M115
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-0370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-794-9729
Provider Business Practice Location Address Fax Number:
718-794-9730
Provider Enumeration Date:
07/21/2006

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: 207RN0300X , with the licence number:  241963-1 , 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: 0187593 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02479087 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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