Healthcare Provider Details

I. General information

NPI: 1356892681
Provider Name (Legal Business Name): BALANCE MEDICAL AND WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 MADISON AVE
LAKEWOOD OH
44107-4510
US

IV. Provider business mailing address

14200 MADISON AVE
LAKEWOOD OH
44107-4510
US

V. Phone/Fax

Practice location:
  • Phone: 330-637-0348
  • Fax: 330-637-0048
Mailing address:
  • Phone: 330-637-0348
  • Fax: 330-637-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-003502
License Number StateOH

VIII. Authorized Official

Name: DR. JENNIFER L PREZIOSO
Title or Position: OWNER
Credential: DPM
Phone: 330-637-0348