Active NPI
Manju Kaur Balu, PHARMD
- Pharmacist
- Bay Shore, NY
National Provider Identifier
1073195459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 067503
- Practice address
- 1760 5TH Ave
Bay Shore, NY 11706-1739 - Phone
- (631) 951-2122
- NPI assigned
- Apr 25, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 067503 | NY | Primary |
Addresses
Primary practice location
1760 5TH Ave
Bay Shore, NY 11706-1739
Mailing address
5 Jerome Ave
Hicksville, NY 11801-2012
Phone (516) 857-5235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 067503 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619308800000",
"number": "1073195459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 JEROME AVE",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118012012",
"telephone_number": "516-857-5235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1760 5TH AVE",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117061739",
"telephone_number": "631-951-2122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALU",
"first_name": "MANJU",
"middle_name": "KAUR",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-25",
"last_updated": "2021-04-25",
"certification_date": "2021-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "067503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.