Provider Demographics
NPI:1114620069
Name:BALAISH, ORI
Entity Type:Individual
Prefix:
First Name:ORI
Middle Name:
Last Name:BALAISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 RIVER ST APT 1037
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5870
Mailing Address - Country:US
Mailing Address - Phone:914-772-4424
Mailing Address - Fax:
Practice Address - Street 1:333 RIVER ST APT 1037
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5870
Practice Address - Country:US
Practice Address - Phone:914-772-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency