Provider Demographics
NPI:1760097927
Name:VITAL BALANCE OSTEOPATHY, PLLC
Entity Type:Organization
Organization Name:VITAL BALANCE OSTEOPATHY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDEN, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-338-1884
Mailing Address - Street 1:10 BOND STREET
Mailing Address - Street 2:STE 1, #290
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:917-338-1884
Mailing Address - Fax:
Practice Address - Street 1:10 BOND STREET
Practice Address - Street 2:STE 1, #290
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:917-338-1884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITAL BALANCE OSTEOPATHY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty