1063642049 NPI number — DANA C BALASSI DIPL.O.M., L.AC.

Table of content: DANA C BALASSI DIPL.O.M., L.AC. (NPI 1063642049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063642049 NPI number — DANA C BALASSI DIPL.O.M., L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALASSI
Provider First Name:
DANA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DIPL.O.M., L.AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063642049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
434 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12866-8627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-579-8267
Provider Business Mailing Address Fax Number:
518-357-8111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 WOODLAWN AVE APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-579-8267
Provider Business Practice Location Address Fax Number:
518-357-8111
Provider Enumeration Date:
07/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 004758 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)