Provider Demographics
NPI:1457197121
Name:BALWANI, DIPTI G
Entity type:Individual
Prefix:
First Name:DIPTI
Middle Name:G
Last Name:BALWANI
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 1:440 E 20TH ST APT MD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8209
Mailing Address - Country:US
Mailing Address - Phone:551-344-7796
Mailing Address - Fax:
Practice Address - Street 1:159 BLEECKER ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1457
Practice Address - Country:US
Practice Address - Phone:917-382-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health