MEDICARE: MIAHAELA BALAESCU MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	216737	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588768865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAHAELA BALAESCU MD PC

Provider Business Mailing Address
First Line	:	4701 QUEENS BLVD
Second Line	:	SUITE 403
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-1600
Country	:	US
Telephone Number	:	718-784-7500
Fax Number	:	718-361-1130

Provider Business Practice Location Address
First Line	:	4701 QUEENS BLVD
Second Line	:	SUITE 403
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-1600
Country	:	US
Telephone Number	:	718-784-7500
Fax Number	:	718-361-1130

Authorized Official
Title or Position	:	OWNER
Name	:	MIHAELA BALAESCU
Credential	:	MD
Telephone Number	:	718-784-7500

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	07/09/2008

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