Provider Demographics
NPI:1528173093
Name:BATTLA, NASREEN N (MD)
Entity type:Individual
Prefix:DR
First Name:NASREEN
Middle Name:N
Last Name:BATTLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 HARRY L DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1423
Mailing Address - Country:US
Mailing Address - Phone:607-777-9475
Mailing Address - Fax:607-797-3131
Practice Address - Street 1:256 HARRY L DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1423
Practice Address - Country:US
Practice Address - Phone:607-777-9475
Practice Address - Fax:607-797-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1801162080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1550325Medicaid
NY10031572OtherCDP HP PCP #