Healthcare Provider Details

I. General information

NPI: 1215456918
Provider Name (Legal Business Name): BALAJI DRUGS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 3RD AVE
SPRING LAKE NJ
07762-1331
US

IV. Provider business mailing address

1206 3RD AVE
SPRING LAKE NJ
07762-1331
US

V. Phone/Fax

Practice location:
  • Phone: 732-449-6157
  • Fax: 732-449-1349
Mailing address:
  • Phone: 732-449-6157
  • Fax: 732-449-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0126977
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0126951
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier0126977
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICAID DME

VIII. Authorized Official

Name: DR. KALYAN DANDU
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 732-449-6157