Basic Information
| Provider Information | |||||||||
| NPI: | 1437159670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALATSKY | ||||||||
| FirstName: | IGOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 200 TRENTON ROAD | ||||||||
| Address2: | |||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098936611 | ||||||||
| FaxNumber: | 3212590635 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 TRENTON ROAD | ||||||||
| Address2: | |||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098936611 | ||||||||
| FaxNumber: | 3214341775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME105590 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 228787 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 25MA09309900 | NJ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 001472700 | 05 | FL | MEDICAID | 02555044 | 05 | NY | MEDICAID | 0365688 | 05 | NJ | MEDICAID |