Provider Demographics
NPI:1740600303
Name:BALESTRIERE, SEBASTIAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:
Last Name:BALESTRIERE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LAMBS RD
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-2000
Mailing Address - Country:US
Mailing Address - Phone:856-248-7191
Mailing Address - Fax:
Practice Address - Street 1:614 LAMBS RD
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2000
Practice Address - Country:US
Practice Address - Phone:856-248-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000412002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer