Basic Information
| Provider Information | |||||||||
| NPI: | 1417025990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANNA | ||||||||
| FirstName: | S BALAVENKATESH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| OtherLastName: | KANNA | ||||||||
| OtherFirstName: | BALAVENKATESH | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD MPH | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5 THERESA LN | ||||||||
| Address2: | |||||||||
| City: | SCARSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105834621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149128320 | ||||||||
| FaxNumber: | 7185794836 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 EAST 149TH STREET | ||||||||
| Address2: | LINCOLN HOSPITAL,SUITE # 8-22, DEPARTMENT OF MEDICINE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
| FaxNumber: | 7185794836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 002137 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.