Provider Demographics
NPI:1053487439
Name:BALASUNDARAM, ANUSUYA (MD)
Entity type:Individual
Prefix:
First Name:ANUSUYA
Middle Name:
Last Name:BALASUNDARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 SPRUCE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6175
Mailing Address - Country:US
Mailing Address - Phone:917-292-4934
Mailing Address - Fax:
Practice Address - Street 1:650 RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-5613
Practice Address - Country:US
Practice Address - Phone:609-267-7000
Practice Address - Fax:609-518-2150
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079439002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0075752Medicaid
NJ094428Medicare ID - Type Unspecified
NJ0075752Medicaid
NJ094428Medicare PIN