Provider Demographics
NPI:1336318062
Name:BALAOING, VIC GUERRERO (PT)
Entity Type:Individual
Prefix:MR
First Name:VIC
Middle Name:GUERRERO
Last Name:BALAOING
Suffix:
Gender:M
Credentials:PT
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 770309
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-0309
Mailing Address - Country:US
Mailing Address - Phone:718-942-5133
Mailing Address - Fax:718-942-5134
Practice Address - Street 1:930 SHERIDAN AVE STE 5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3339
Practice Address - Country:US
Practice Address - Phone:718-942-5133
Practice Address - Fax:718-942-5134
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1316331200OtherGROUP NPI
NY03374870Medicaid
NY1336318062OtherNPI