Healthcare Provider Details

I. General information

NPI: 1639092497
Provider Name (Legal Business Name): CHABIYA BALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 48TH ST FL 1
BROOKLYN NY
11219-2919
US

IV. Provider business mailing address

2394 OCEANCREST BLVD
FAR ROCKAWAY NY
11691-2677
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7599
  • Fax: 718-635-7492
Mailing address:
  • Phone: 919-358-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP143803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: