Healthcare Provider Details

I. General information

NPI: 1154818664
Provider Name (Legal Business Name): KRYSTAL BALAGOT RIVERA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRYSTAL BALAGOT DO

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 ROUTE 70 W
CHERRY HILL NJ
08002-3315
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-3597
  • Fax: 856-795-7590
Mailing address:
  • Phone: 848-288-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MB11155600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: