Provider Demographics
NPI:1891513008
Name:BALANCE GROUP LLC
Entity type:Organization
Organization Name:BALANCE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:GUZEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:ZOLKORNYAEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-503-5887
Mailing Address - Street 1:359 PENNINGTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3615
Mailing Address - Country:US
Mailing Address - Phone:609-503-5887
Mailing Address - Fax:609-503-5466
Practice Address - Street 1:359 PENNINGTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3615
Practice Address - Country:US
Practice Address - Phone:609-503-5887
Practice Address - Fax:609-503-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1043226Medicaid