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General NPI Number Information
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NPI Number | 1619645009
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Entity Type | Individual
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Provider Name | MICHAEL BALADI
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Gender | Male
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 397 ROUTE 46 W
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1967
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Country | US
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Telephone | 862-210-3980
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Fax |
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Provider Business Mailing Address
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Address Line | 39 SLOPING HILL TER
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City | WAYNE
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State | NJ
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Zip | 07470-4212
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Country | US
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Telephone | 973-207-2576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 28RI04198700
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License Number State | NJ
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