Provider Demographics
NPI:1417025990
Name:KANNA, S BALAVENKATESH
Entity type:Individual
Prefix:DR
First Name:S BALAVENKATESH
Middle Name:
Last Name:KANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BALAVENKATESH
Other - Middle Name:
Other - Last Name:KANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MPH
Mailing Address - Street 1:5 THERESA LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4621
Mailing Address - Country:US
Mailing Address - Phone:914-912-8320
Mailing Address - Fax:718-579-4836
Practice Address - Street 1:234 EAST 149TH STREET
Practice Address - Street 2:LINCOLN HOSPITAL,SUITE # 8-22, DEPARTMENT OF MEDICINE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5000
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine