Provider Demographics
NPI:1215997887
Name:BALOT, BARRY HAL (DO)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:HAL
Last Name:BALOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 E SUNRISE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2598
Mailing Address - Country:US
Mailing Address - Phone:631-225-6200
Mailing Address - Fax:631-225-3419
Practice Address - Street 1:150 E SUNRISE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-225-6200
Practice Address - Fax:631-225-3419
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167908-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF20384Medicare UPIN
NY26E023Medicare PIN