1821891458 NPI number — EDWARD BALZER, NURSE PRACTITIONER IN PSYCHIATRY, P.C.

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 1821891458 NPI number — EDWARD BALZER, NURSE PRACTITIONER IN PSYCHIATRY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD BALZER, NURSE PRACTITIONER IN PSYCHIATRY, P.C.
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:
1821891458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASTIC BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11951-0601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-681-5584
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 RIVIERA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASTIC BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11951-6024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-681-5584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BALZER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
631-681-5584

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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