Healthcare Provider Details

I. General information

NPI: 1588210405
Provider Name (Legal Business Name): MRS. KAREN VALERIE BALSAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN VALERIE HARKINS RN

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 AIRPORT RD
LAKEWOOD NJ
08701-5907
US

IV. Provider business mailing address

173 CHERRY QUAY RD
BRICK NJ
08723-6303
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-4700
  • Fax: 732-364-4190
Mailing address:
  • Phone: 908-814-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number26NO06598000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: