MEDICARE: EDMOND JOHN BALATBAT MEJIA-VENTURA

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1508726530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMOND JOHN BALATBAT MEJIA-VENTURA

Provider Business Mailing Address
First Line	:	7 S MAIN ST STE B
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1578
Country	:	US
Telephone Number	:	833-660-7465
Fax Number	:	312-600-4447

Provider Business Practice Location Address
First Line	:	7 S MAIN ST STE B
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1578
Country	:	US
Telephone Number	:	833-660-7465
Fax Number	:	312-600-4447

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

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	11/13/2025

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