Healthcare Provider Details

I. General information

NPI: 1588751663
Provider Name (Legal Business Name): BALKRISHNA KALAYAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAMARONECK AVE STE 400
HARRISON NY
10528-1613
US

IV. Provider business mailing address

600 MAMARONECK AVE STE 400
HARRISON NY
10528-1613
US

V. Phone/Fax

Practice location:
  • Phone: 914-468-0874
  • Fax:
Mailing address:
  • Phone: 914-468-0874
  • Fax: 914-468-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number142224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: