Provider Demographics
NPI:1821891458
Name:EDWARD BALZER, NURSE PRACTITIONER IN PSYCHIATRY, P.C.
Entity type:Organization
Organization Name:EDWARD BALZER, NURSE PRACTITIONER IN PSYCHIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BALZER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:631-681-5584
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-0601
Mailing Address - Country:US
Mailing Address - Phone:631-681-5584
Mailing Address - Fax:
Practice Address - Street 1:51 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-6024
Practice Address - Country:US
Practice Address - Phone:631-681-5584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty