Healthcare Provider Details

I. General information

NPI: 1487879037
Provider Name (Legal Business Name): CENTER FOR BALANCED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 WASHINGTON ST
CORTLANDT MANOR NY
10567-5906
US

IV. Provider business mailing address

1326 WASHINGTON ST P.O. BOX 801
CORTLANDT MANOR NY
10567-5906
US

V. Phone/Fax

Practice location:
  • Phone: 914-736-2998
  • Fax: 914-788-0161
Mailing address:
  • Phone: 914-736-2998
  • Fax: 914-788-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberX008908
License Number StateNY

VIII. Authorized Official

Name: MRS. ARDYS CAMPBELL BENJAMIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 914-736-2998