Provider Demographics
NPI:1588751663
Name:KALAYAM, BALKRISHNA (MD)
Entity type:Individual
Prefix:
First Name:BALKRISHNA
Middle Name:
Last Name:KALAYAM
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 1:600 MAMARONECK AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1613
Mailing Address - Country:US
Mailing Address - Phone:914-468-0874
Mailing Address - Fax:914-468-0878
Practice Address - Street 1:600 MAMARONECK AVE
Practice Address - Street 2:STE 400
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1613
Practice Address - Country:US
Practice Address - Phone:914-468-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1422242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37E30Medicare PIN
NYE06971Medicare UPIN