Healthcare Provider Details

I. General information

NPI: 1770576399
Provider Name (Legal Business Name): JOSEPH SCOTT BALER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PALISADES DR STE 240
ALBANY NY
12205-1443
US

IV. Provider business mailing address

4 PALISADES DR STE 240
ALBANY NY
12205-1443
US

V. Phone/Fax

Practice location:
  • Phone: 578-446-0172
  • Fax: 518-446-0182
Mailing address:
  • Phone: 578-446-0172
  • Fax: 518-446-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number171899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: