Provider Demographics
NPI:1124353271
Name:LOCKWOOD ENDOSCOPY AND OFFICE BASED SURGERY PC
Entity type:Organization
Organization Name:LOCKWOOD ENDOSCOPY AND OFFICE BASED SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALA
Authorized Official - Middle Name:MURTHY
Authorized Official - Last Name:BALAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:914-235-2329
Mailing Address - Street 1:140 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4915
Mailing Address - Country:US
Mailing Address - Phone:914-235-2329
Mailing Address - Fax:914-355-2490
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-235-2329
Practice Address - Fax:914-355-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3399261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical