MEDICARE: DR. VENUGOPAL BALASUBRAMANIAN

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	235Z00000X	Speech-Language Pathologist	41YS00346900	NJ

General Provider Information

NPI Number	:	1679718589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENUGOPAL BALASUBRAMANIAN

Provider Business Mailing Address
First Line	:	14 THORNTON LN
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-5044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S ORANGE AVE
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2646
Country	:	US
Telephone Number	:	973-275-2912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	12/05/2008

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Directions to “ DR. VENUGOPAL BALASUBRAMANIAN ” Practice Location

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