Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 034722-2 | NY |
Y | 213EG0000X | General Practice | 034722-2 | NY |
NPI | 1003091745 |
---|---|
Provider Name | Dr. Seth E Balish |
First Address | Staten Island, NY 10314-6603 |
Second Address | Staten Island, NY 10314-6603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2007 |
Last Update Date | 31/12/2007 |