Provider Demographics
NPI:1801980461
Name:BALYSKY, ANDREW I (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:I
Last Name:BALYSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 EAST MAIN STREET BOX 521
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930
Mailing Address - Country:US
Mailing Address - Phone:908-879-7070
Mailing Address - Fax:908-879-5323
Practice Address - Street 1:530 EAST MAIN STREET BOX 521
Practice Address - Street 2:SUITE 2B
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:908-879-7070
Practice Address - Fax:908-879-5323
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006546P152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
NJ27OA00466700152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222735687OtherTAX ID
NJ0584730001OtherDMERC
NJ222735687OtherTAX ID
NJ0584730001OtherDMERC