Healthcare Provider Details

I. General information

NPI: 1497834865
Provider Name (Legal Business Name): R & J BALAGOT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4277 HEMPSTEAD TPKE SUITE 107
BETHPAGE NY
11714
US

IV. Provider business mailing address

4277 HEMPSTEAD TPKE SUITE 107
BETHPAGE NY
11714
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-0665
  • Fax: 516-731-6160
Mailing address:
  • Phone: 516-731-0665
  • Fax: 516-731-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number148675
License Number StateNY

VIII. Authorized Official

Name: JOCELYN BARAL-BALAGOT
Title or Position: OWNER
Credential: MD
Phone: 516-731-0124