Healthcare Provider Details

I. General information

NPI: 1003606989
Provider Name (Legal Business Name): CARLY ELIZABETH BALES MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COMMUNITY DR
GREAT NECK NY
11021-5503
US

IV. Provider business mailing address

225 COMMUNITY DR RM 110
GREAT NECK NY
11021-5506
US

V. Phone/Fax

Practice location:
  • Phone: 516-918-4800
  • Fax:
Mailing address:
  • Phone: 516-918-4800
  • Fax: 516-918-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: