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General NPI Number Information
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NPI Number | 1356892681
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Entity Type | Organization
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Legal Business Name | BALANCE MEDICAL AND WELLNESS GROUP LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 14200 MADISON AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-4510
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Country | US
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Telephone | 330-637-0348
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Fax | 330-637-0048
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Provider Business Mailing Address
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Address Line | 14200 MADISON AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-4510
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Country | US
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Telephone | 330-637-0348
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Fax | 330-637-0048
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER L PREZIOSO
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Credential | DPM
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Telephone | 330-637-0348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36-003502
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License Number State | OH
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