Healthcare Provider Details

I. General information

NPI: 1275502957
Provider Name (Legal Business Name): ASWINE K BAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 DAVIS AVE SUITE 1
NEPTUNE NJ
07753-4401
US

IV. Provider business mailing address

61 DAVIS AVE SUITE 1
NEPTUNE NJ
07753-4401
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4271
  • Fax: 732-776-4867
Mailing address:
  • Phone: 732-776-4271
  • Fax: 732-776-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number25MA05449000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: