Provider Demographics
NPI:1124599600
Name:NORMAN P. BALACUIT DPM INC
Entity Type:Organization
Organization Name:NORMAN P. BALACUIT DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALACUIT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:909-717-8327
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-0851
Mailing Address - Country:US
Mailing Address - Phone:909-717-8327
Mailing Address - Fax:626-357-7708
Practice Address - Street 1:416 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2812
Practice Address - Country:US
Practice Address - Phone:626-357-7721
Practice Address - Fax:626-357-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty