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General NPI Number Information
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NPI Number | 1760097927
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Entity Type | Organization
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Legal Business Name | VITAL BALANCE OSTEOPATHY, PLLC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 10 BOND STREET STE 1, #290
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 917-338-1884
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BOND STREET STE 1, #290
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City | GREAT NECK
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State | NY
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Zip | 11021
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Country | US
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Telephone | 917-338-1884
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Fax |
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Authorized Official
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Title or Position | OWNER, PRESIDEN, PHYSICIAN
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Name | DR. LISA PRESTON
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Credential | DO
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Telephone | 917-338-1884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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