Provider Demographics
NPI:1386961142
Name:BALANI, ANGELI H
Entity type:Individual
Prefix:MISS
First Name:ANGELI
Middle Name:H
Last Name:BALANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 FRONTSTREET
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:ST. MAARTEN
Mailing Address - Zip Code:1049
Mailing Address - Country:AN
Mailing Address - Phone:860-866-4714
Mailing Address - Fax:
Practice Address - Street 1:8 DEVINE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2172
Practice Address - Country:US
Practice Address - Phone:203-281-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008762174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist