Healthcare Provider Details

I. General information

NPI: 1487995809
Provider Name (Legal Business Name): CHARLES ANTHONY BALKUS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 05/10/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 MAIN ST
DANSVILLE NY
14437-9753
US

IV. Provider business mailing address

77 STANLEY ST P.O. BOX 403
MOUNT MORRIS NY
14510-1413
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4010
  • Fax: 585-335-4001
Mailing address:
  • Phone: 585-658-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number367926-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: