1487879037 NPI number — CENTER FOR BALANCED HEALTH LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487879037 NPI number — CENTER FOR BALANCED HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR BALANCED HEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1487879037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1326 WASHINGTON ST
Provider Second Line Business Mailing Address:
P.O. BOX 801
Provider Business Mailing Address City Name:
CORTLANDT MANOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10567-5906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-736-2998
Provider Business Mailing Address Fax Number:
914-788-0161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1326 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTLANDT MANOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10567-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-736-2998
Provider Business Practice Location Address Fax Number:
914-788-0161
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENJAMIN
Authorized Official First Name:
ARDYS
Authorized Official Middle Name:
CAMPBELL
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
914-736-2998

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  X008908 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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