Provider Demographics
NPI:1215945845
Name:BALMIKI, RAJEEV (MD)
Entity type:Individual
Prefix:
First Name:RAJEEV
Middle Name:
Last Name:BALMIKI
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 1:744 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2054
Mailing Address - Country:US
Mailing Address - Phone:718-765-0761
Mailing Address - Fax:718-765-0498
Practice Address - Street 1:705 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3232
Practice Address - Country:US
Practice Address - Phone:718-765-0761
Practice Address - Fax:718-765-0498
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176969207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE94666Medicare UPIN
NY79F691Medicare PIN