Healthcare Provider Details

I. General information

NPI: 1275161911
Provider Name (Legal Business Name): CHANDRA ABIRAMI BALASUBRAMANIAPANDIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CENTRAL AVE STE 100
EAST ORANGE NJ
07018-2838
US

IV. Provider business mailing address

25 POCONO RD
DENVILLE NJ
07834-2954
US

V. Phone/Fax

Practice location:
  • Phone: 862-520-3104
  • Fax:
Mailing address:
  • Phone: 973-625-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA12675500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: