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General NPI Number Information
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NPI Number | 1932177870
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Entity Type | Individual
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Provider Name | EDWARD BALACI MD
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 04/27/2019
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Provider Practice Location Address
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Address Line | 32-36 HARRISON ST
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2122
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Country | US
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Telephone | 607-729-1999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | CANAJOHARIE
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State | NY
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Zip | 13317-0023
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Country | US
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Telephone | 607-729-2125
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 210748
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 210748
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License Number State | NY
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