MEDICARE: RINA BALSAM LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06937300	NJ

General Provider Information

NPI Number	:	1265268452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RINA BALSAM LSW

Provider Business Mailing Address
First Line	:	108 LEONARD ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2049
Country	:	US
Telephone Number	:	323-304-4692
Fax Number	:

Provider Business Practice Location Address
First Line	:	1172 FISCHER BLVD
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3096
Country	:	US
Telephone Number	:	732-534-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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