Provider Demographics
NPI:1194903872
Name:BALESTRIERI, HEATHER VICCARO (LAC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:VICCARO
Last Name:BALESTRIERI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:SAHOURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:155 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1918
Mailing Address - Country:US
Mailing Address - Phone:201-956-2516
Mailing Address - Fax:201-327-8450
Practice Address - Street 1:146 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2821
Practice Address - Country:US
Practice Address - Phone:201-956-2516
Practice Address - Fax:201-956-2516
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00093000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist