Provider Demographics
NPI:1700036464
Name:BALON, MONICA K (PA)
Entity Type:Individual
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First Name:MONICA
Middle Name:K
Last Name:BALON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1470
Mailing Address - Country:US
Mailing Address - Phone:716-706-2034
Mailing Address - Fax:716-706-2035
Practice Address - Street 1:27 FRANKLIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1375
Practice Address - Country:US
Practice Address - Phone:716-592-7400
Practice Address - Fax:716-592-7519
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2012-09-14
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Provider Licenses
StateLicense IDTaxonomies
NY012755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03056466Medicaid