Provider Demographics
NPI:1104066281
Name:BALANOVSKY, INGA (OTR/L)
Entity type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:BALANOVSKY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601A SURF AVE APT 15F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3417
Mailing Address - Country:US
Mailing Address - Phone:718-414-5838
Mailing Address - Fax:
Practice Address - Street 1:2928 W 5TH ST
Practice Address - Street 2:APT#21M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3902
Practice Address - Country:US
Practice Address - Phone:718-414-5838
Practice Address - Fax:718-333-0304
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP68779OtherLICENSE NUMBER