Healthcare Provider Details

I. General information

NPI: 1225113608
Provider Name (Legal Business Name): SOPHIE J BALK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEDS ACADEMIC ASSOC AT CFCC 1621 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

65 HUNTER AVE
NEW ROCHELLE NY
10801-2013
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8090
  • Fax: 718-405-8091
Mailing address:
  • Phone: 718-405-8090
  • Fax: 718-405-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: