=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063642049
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA C BALASSI DIPL.O.M., L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2009
-----------------------------------------------------
Last Update Date | 06/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 WOODLAWN AVE APT 2
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-579-8267
-----------------------------------------------------
Fax | 518-357-8111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 CHURCH ST
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-8627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-579-8267
-----------------------------------------------------
Fax | 518-357-8111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 004758
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------