Provider Demographics
NPI:1124054747
Name:SAPPAL, BALJIT S (MD)
Entity type:Individual
Prefix:DR
First Name:BALJIT
Middle Name:S
Last Name:SAPPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2347
Mailing Address - Country:US
Mailing Address - Phone:908-351-8989
Mailing Address - Fax:908-351-8879
Practice Address - Street 1:725 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2347
Practice Address - Country:US
Practice Address - Phone:908-351-8989
Practice Address - Fax:908-351-8879
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08077700207R00000X
PAMD428236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0110892Medicaid
NJ0110892Medicaid