Provider Demographics
NPI:1679242242
Name:BALANCE: FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:BALANCE: FOOT AND ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PREZIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-658-0111
Mailing Address - Street 1:14200 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4510
Mailing Address - Country:US
Mailing Address - Phone:216-658-0111
Mailing Address - Fax:216-658-0110
Practice Address - Street 1:7580 AUBURN RD STE 102
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077-9616
Practice Address - Country:US
Practice Address - Phone:216-658-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALANCE FOOT AND ANKLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty