Provider Demographics
NPI:1457673683
Name:BALKON, CRAIG JOSEPH
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:JOSEPH
Last Name:BALKON
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 1:2784 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3639
Mailing Address - Country:US
Mailing Address - Phone:516-826-3144
Mailing Address - Fax:516-826-3144
Practice Address - Street 1:2784 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3639
Practice Address - Country:US
Practice Address - Phone:516-826-3144
Practice Address - Fax:516-826-3144
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053325-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist