Provider Demographics
NPI:1669908976
Name:BALANCE ACUPUNCTURE OF L.I
Entity type:Organization
Organization Name:BALANCE ACUPUNCTURE OF L.I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-219-5369
Mailing Address - Street 1:16 SATELLITE DR
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2914
Mailing Address - Country:US
Mailing Address - Phone:631-219-5369
Mailing Address - Fax:
Practice Address - Street 1:16 SATELLITE DR
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2914
Practice Address - Country:US
Practice Address - Phone:631-219-5369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty