Provider Demographics
NPI:1801223789
Name:JULIA LICHTY BALAY
Entity Type:Organization
Organization Name:JULIA LICHTY BALAY
Other - Org Name:JLB NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LICHTY
Authorized Official - Last Name:BALAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD CSSD
Authorized Official - Phone:917-596-3998
Mailing Address - Street 1:100 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2141
Mailing Address - Country:US
Mailing Address - Phone:917-596-3998
Mailing Address - Fax:
Practice Address - Street 1:100 UNION AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2141
Practice Address - Country:US
Practice Address - Phone:917-596-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
960371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
960371OtherCOMMISION ON DIETETIC REGISTRATION