Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 179342-1 | NY |
Y | 111NI0900X | Internist | 179342-1 | NY |
N | 207RG0300X | Geriatric Medicine | 179342-1 | NY |
NPI | 1023041019 |
---|---|
Provider Name | Balvindar S Sareen |
First Address | Fond Du Lac, WI 54935-4560 |
Second Address | Fond Du Lac, WI 54935-4560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 12/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E59132 | (02) | NY |