Provider Demographics
NPI:1821251323
Name:STAHL BALABAN, CELESTE (DO)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:STAHL BALABAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14105-1027
Mailing Address - Country:US
Mailing Address - Phone:716-735-7774
Mailing Address - Fax:
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-1027
Practice Address - Country:US
Practice Address - Phone:716-735-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009698207R00000X
NY60.258257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine