Provider Demographics
NPI:1093191702
Name:BALAGULA, ALEKSEY (MSED)
Entity type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:BALAGULA
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 65TH ST
Mailing Address - Street 2:APT# 28C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4948
Mailing Address - Country:US
Mailing Address - Phone:646-404-4096
Mailing Address - Fax:
Practice Address - Street 1:350 65TH ST
Practice Address - Street 2:APT# 28C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4948
Practice Address - Country:US
Practice Address - Phone:646-404-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist