Provider Demographics
NPI:1639480379
Name:BALABAN, RACHEL (MED)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BALABAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ALTAMONT DR
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-5900
Mailing Address - Country:US
Mailing Address - Phone:845-339-2747
Mailing Address - Fax:
Practice Address - Street 1:124 ALTAMONT DR
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443-5900
Practice Address - Country:US
Practice Address - Phone:845-339-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency