Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F305718-1 | NY |
NPI | 1023386935 |
---|---|
Provider Name | Mr. Michael Stephen Balletta |
First Address | New York, NY 10025-1716 |
Second Address | New York, NY 10025-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2011 |
Last Update Date | 02/05/2013 |