Healthcare Provider Details

I. General information

NPI: 1811359144
Provider Name (Legal Business Name): BALANCING HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 51ST ST SUITE 2
WEST NEW YORK NJ
07093-5553
US

IV. Provider business mailing address

516 51ST ST SUITE 2
WEST NEW YORK NJ
07093-5553
US

V. Phone/Fax

Practice location:
  • Phone: 201-293-5002
  • Fax:
Mailing address:
  • Phone: 201-293-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE MANUEL SOTO-PERELLO
Title or Position: MEMBER
Credential: M.D.
Phone: 646-234-8357