Provider Demographics
NPI:1356892681
Name:BALANCE MEDICAL AND WELLNESS GROUP LLC
Entity type:Organization
Organization Name:BALANCE MEDICAL AND WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PREZIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-637-0348
Mailing Address - Street 1:14200 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4510
Mailing Address - Country:US
Mailing Address - Phone:330-637-0348
Mailing Address - Fax:330-637-0048
Practice Address - Street 1:14200 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4510
Practice Address - Country:US
Practice Address - Phone:330-637-0348
Practice Address - Fax:330-637-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003502213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty