=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891513008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALANCE GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2024
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 359 PENNINGTON AVE STE 3
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618-3615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-503-5887
-----------------------------------------------------
Fax | 609-503-5466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 359 PENNINGTON AVE STE 3
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618-3615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-503-5887
-----------------------------------------------------
Fax | 609-503-5466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PIC
-----------------------------------------------------
Name | GUZEL I ZOLKORNYAEVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-503-5887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------