Provider Demographics
NPI:1700374782
Name:BALBUENA, JENNY E
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:E
Last Name:BALBUENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 GRAND CONCOURSE APT L3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1534
Mailing Address - Country:US
Mailing Address - Phone:718-220-2433
Mailing Address - Fax:
Practice Address - Street 1:3010 GRAND CONCOURSE APT L3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1534
Practice Address - Country:US
Practice Address - Phone:718-220-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator