=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932788478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALANCE PSYCHIATRY SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2021
-----------------------------------------------------
Last Update Date | 04/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 MOUNTAIN BLVD STE 303
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07059-5605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-907-7362
-----------------------------------------------------
Fax | 343-503-0648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 OLD DUTCH RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07059-7164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-485-7326
-----------------------------------------------------
Fax | 343-503-0648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHILIN R PANDYA
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 732-485-7326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------