Healthcare Provider Details

I. General information

NPI: 1750195707
Provider Name (Legal Business Name): BALANCE360 HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 CONVERY BLVD
PERTH AMBOY NJ
08861-1937
US

IV. Provider business mailing address

1107 CONVERY BLVD
PERTH AMBOY NJ
08861-1937
US

V. Phone/Fax

Practice location:
  • Phone: 732-910-7807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRAN D KAUR
Title or Position: FNP
Credential: NP
Phone: 732-910-7807