Healthcare Provider Details

I. General information

NPI: 1487201380
Provider Name (Legal Business Name): PH BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2019
Last Update Date: 08/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 JORENE DR
EGG HARBOR TWP NJ
08234-7545
US

IV. Provider business mailing address

PO BOX 7885
ATLANTIC CITY NJ
08404-7885
US

V. Phone/Fax

Practice location:
  • Phone: 609-350-2580
  • Fax:
Mailing address:
  • Phone: 609-350-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARTE KING
Title or Position: DIRECTOR
Credential:
Phone: 609-350-2580