Provider Demographics
NPI:1295772168
Name:BALZANI, HENRY H (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:H
Last Name:BALZANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1117 ROUTE 46 EAST CLIFTON
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2449
Mailing Address - Country:US
Mailing Address - Phone:973-777-5819
Mailing Address - Fax:973-777-1078
Practice Address - Street 1:1117 ROUTE 46 EAST CLIFTON
Practice Address - Street 2:SUITE 204
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2449
Practice Address - Country:US
Practice Address - Phone:973-777-5819
Practice Address - Fax:973-777-1078
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA39879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3290204Medicaid
NJC56541Medicare UPIN
NJ505842Medicare ID - Type Unspecified