Healthcare Provider Details

I. General information

NPI: 1972779098
Provider Name (Legal Business Name): ANIL R BALANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CAPITAL WAY STE 380
PENNINGTON NJ
08534-2521
US

IV. Provider business mailing address

2 CAPITAL WAY STE 456
PENNINGTON NJ
08534-2521
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-5000
  • Fax: 609-537-5050
Mailing address:
  • Phone: 609-537-5000
  • Fax: 609-537-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number236993
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD434248
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA08408000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: