1598818023 NPI number — JULIE LICHTY BALAY MS, RD, CSSD

Table of content: JULIE LICHTY BALAY MS, RD, CSSD (NPI 1598818023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598818023 NPI number — JULIE LICHTY BALAY MS, RD, CSSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALAY
Provider First Name:
JULIE
Provider Middle Name:
LICHTY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CSSD
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:
1598818023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 MILTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESSKILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07626-2115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-596-3998
Provider Business Mailing Address Fax Number:
201-544-1004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 COUNTY RD STE 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESSKILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07626-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-596-3998
Provider Business Practice Location Address Fax Number:
201-554-1004
Provider Enumeration Date:
01/19/2007

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: 133V00000X , with the licence number:  960371 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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