Provider Demographics
NPI:1316316789
Name:BALANCE MEDICAL PROFESSIONAL PRIMARY SERVICES PLLC
Entity type:Organization
Organization Name:BALANCE MEDICAL PROFESSIONAL PRIMARY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:M
Authorized Official - Last Name:TALLAJ
Authorized Official - Suffix:
Authorized Official - Credentials:204704
Authorized Official - Phone:212-567-4918
Mailing Address - Street 1:5030 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034
Mailing Address - Country:US
Mailing Address - Phone:212-567-4918
Mailing Address - Fax:212-567-4957
Practice Address - Street 1:1150 WEBSTER AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-975-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty