Provider Demographics
NPI:1508417676
Name:BALYINT, NICHOLAS (PMHNP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BALYINT
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 BROADWAY APT 121
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4890
Mailing Address - Country:US
Mailing Address - Phone:330-605-0449
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY STE 1605
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3756
Practice Address - Country:US
Practice Address - Phone:212-693-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402844363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health