Provider Demographics
NPI:1306368295
Name:BALINGCONGAN, EROLL
Entity Type:Individual
Prefix:
First Name:EROLL
Middle Name:
Last Name:BALINGCONGAN
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:PO BOX 5024
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5024
Mailing Address - Country:US
Mailing Address - Phone:800-627-4470
Mailing Address - Fax:412-937-5710
Practice Address - Street 1:1 GUSTAVE L LEVY PL # 1010
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:800-627-4470
Practice Address - Fax:412-937-5710
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730714367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA761685OtherCALIFORNIA BOARD OF NURSING
NY730714OtherNYS EDUCATION DEPARTMENT, OFFICE OF THE PROFESSIONS, RN LICENSING