Healthcare Provider Details
I. General information
NPI: 1790938819
Provider Name (Legal Business Name): IN-BALANCE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8 CHESTNUT RIDGE RD
MONTVALE NJ
07645-1802
US
IV. Provider business mailing address
10 SHIELD DR
WOODCLIFF LAKE NJ
07677-8128
US
V. Phone/Fax
- Phone: 201-391-8282
- Fax:
- Phone: 201-476-0020
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | MA050161 |
| License Number State | NJ |
VIII. Authorized Official
Name: DR.
RICK
OWEN
LAMBERT
Title or Position: OWNER
Credential: M.D.
Phone: 201-476-0020