Provider Demographics
NPI:1588615348
Name:HEALTHLINE BALANCE CENTER INC
Entity Type:Organization
Organization Name:HEALTHLINE BALANCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOMOLNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-653-2021
Mailing Address - Street 1:951 NE 167TH ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3711
Mailing Address - Country:US
Mailing Address - Phone:305-653-2021
Mailing Address - Fax:954-474-7605
Practice Address - Street 1:951 NE 167TH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3711
Practice Address - Country:US
Practice Address - Phone:305-653-2021
Practice Address - Fax:954-474-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6239261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4695Medicare ID - Type UnspecifiedIDTF