Provider Demographics
NPI:1720069826
Name:BALSAMO, DONATO MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:DONATO
Middle Name:MICHAEL
Last Name:BALSAMO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1010 NORTHERN BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5329
Mailing Address - Country:US
Mailing Address - Phone:516-233-2484
Mailing Address - Fax:516-304-5850
Practice Address - Street 1:197 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2703
Practice Address - Country:US
Practice Address - Phone:631-691-1500
Practice Address - Fax:631-691-1503
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-10-17
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Provider Licenses
StateLicense IDTaxonomies
NY209721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01872095Medicaid
NY01872095Medicaid