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NPI Code Detail

MEDICARE: DR. BALAJI SRINIVASAN DDS

MEDICARE: DR. BALAJI SRINIVASAN DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDI19411NJ

General Provider Information

NPI Number : 1184832164
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BALAJI SRINIVASAN DDS
Provider Business Mailing Address
First Line : 26 BRENTWOOD DR
Second Line :
City : BAYVILLE
State : NJ
Zip : 08721-2159
Country : US
Telephone Number : 732-606-9194
Fax Number :
Provider Business Practice Location Address
First Line : 1700 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1253
Country : US
Telephone Number : 732-363-5370
Fax Number : 732-364-5684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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Directions to “ DR. BALAJI SRINIVASAN DDS” Practice Location

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