Provider Demographics
NPI:1336295153
Name:BALKO, ROBERT ALFONS (DAC, L AC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALFONS
Last Name:BALKO
Suffix:
Gender:M
Credentials:DAC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2777
Mailing Address - Country:US
Mailing Address - Phone:730-775-0033
Mailing Address - Fax:
Practice Address - Street 1:902 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2777
Practice Address - Country:US
Practice Address - Phone:730-775-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000798171100000X
NJ25MZ00041500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist