MEDICARE: JULIE LICHTY BALAY MS, RD, CSSD

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	133V00000X	Registered Dietitian	960371

General Provider Information

NPI Number	:	1598818023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LICHTY BALAY MS, RD, CSSD

Provider Business Mailing Address
First Line	:	31 MILTON ST
Second Line	:
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-2115
Country	:	US
Telephone Number	:	917-596-3998
Fax Number	:	201-544-1004

Provider Business Practice Location Address
First Line	:	155 COUNTY RD STE 16
Second Line	:
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-2200
Country	:	US
Telephone Number	:	917-596-3998
Fax Number	:	201-554-1004

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	05/14/2025

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