Organization
KANCHANA BALA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANCHANA BALASUBRAMANIAN M.D (PRESIDENT)
(201) 893-2939
Entity
Organization
Contact information
Practice address
6 WALTER CT, RUTHERFORD, NJ 07070-2558
(201) 893-2939
(201) 460-0770
Mailing address
6 WALTER CT, RUTHERFORD, NJ 07070-2558
(201) 893-2939
(201) 460-0770
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA07605600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016497
—
NJ
Enumeration date
02/09/2007
Last updated
01/20/2011
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