Provider Demographics
NPI:1003957804
Name:BALURAN, RICHARD M (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BALURAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4109
Mailing Address - Country:US
Mailing Address - Phone:917-847-6761
Mailing Address - Fax:
Practice Address - Street 1:250 W 64TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6402
Practice Address - Country:US
Practice Address - Phone:212-769-6244
Practice Address - Fax:212-769-7825
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015782-1225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4965321OtherLICENSE