Healthcare Provider Details

I. General information

NPI: 1033432992
Provider Name (Legal Business Name): BALANCE AND MEMORY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14-23 RIVER RD
FAIR LAWN NJ
07410-1240
US

IV. Provider business mailing address

14-23 RIVER RD
FAIR LAWN NJ
07410-1240
US

V. Phone/Fax

Practice location:
  • Phone: 201-703-0600
  • Fax:
Mailing address:
  • Phone: 201-703-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MORRIS TILSON
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 201-703-0600