Provider Demographics
NPI:1902031172
Name:BALAS, GAIL C (LMT)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:C
Last Name:BALAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 LEXINGTON AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8553
Mailing Address - Country:US
Mailing Address - Phone:212-755-1607
Mailing Address - Fax:
Practice Address - Street 1:767 LEXINGTON AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8553
Practice Address - Country:US
Practice Address - Phone:212-755-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005141-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist