Healthcare Provider Details

I. General information

NPI: 1205330412
Provider Name (Legal Business Name): LAUREN BALKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 70TH ST
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

505 E 70TH ST
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-9663
  • Fax: 212-746-3609
Mailing address:
  • Phone: 212-746-9663
  • Fax: 212-746-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number311334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: