Healthcare Provider Details

I. General information

NPI: 1194734079
Provider Name (Legal Business Name): RHODE ISLAND CENTER FOR BALANCE DISORDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RESERVOIR AVE SUITE 7
CRANSTON RI
02910-4448
US

IV. Provider business mailing address

725 RESERVOIR AVE SUITE 7
CRANSTON RI
02910-4448
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-6510
  • Fax: 401-943-2379
Mailing address:
  • Phone: 401-944-6510
  • Fax: 401-943-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5879
License Number StateRI

VIII. Authorized Official

Name: ANTHONY J BARONE
Title or Position: OWNER
Credential: M.D.
Phone: 401-944-6510