Provider Demographics
NPI:1578557138
Name:BALBOA, HENRY M (DPM)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:M
Last Name:BALBOA
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:100 MANETTO HILL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1311
Mailing Address - Country:US
Mailing Address - Phone:516-822-9595
Mailing Address - Fax:516-822-9582
Practice Address - Street 1:100 MANETTO HILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-822-9595
Practice Address - Fax:516-822-9582
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2012-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYN002265213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50712Medicare UPIN