Provider Demographics
NPI:1598818023
Name:BALAY, JULIE LICHTY (MS, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LICHTY
Last Name:BALAY
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2141
Mailing Address - Country:US
Mailing Address - Phone:917-596-3998
Mailing Address - Fax:201-266-6623
Practice Address - Street 1:100 UNION AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2141
Practice Address - Country:US
Practice Address - Phone:917-596-3998
Practice Address - Fax:201-266-6623
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
960371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered