Provider Demographics
NPI:1417038076
Name:BALCH, JUDITH A (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:BALCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STATE RTE #365
Mailing Address - Street 2:
Mailing Address - City:HOLLAND PATENT
Mailing Address - State:NY
Mailing Address - Zip Code:13354-3649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:315-361-2914
Practice Address - Street 1:STATE RTE #365
Practice Address - Street 2:
Practice Address - City:HOLLAND PATENT
Practice Address - State:NY
Practice Address - Zip Code:13354-3649
Practice Address - Country:US
Practice Address - Phone:315-335-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02933388Medicaid
NYRB1535Medicare PIN