Provider Demographics
NPI:1033277827
Name:BALZORA, JEAN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:DANIEL
Last Name:BALZORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E 149TH ST
Mailing Address - Street 2:DEPT. OF MEDICINE-8TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5504
Mailing Address - Country:US
Mailing Address - Phone:718-579-5000
Mailing Address - Fax:718-579-4836
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE,8TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5000
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09692Medicare UPIN