Provider Information for 1790417673
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ALEXA BALISKI
Sex: Female
NPI: 1790417673
Last Updated: 2022-08-01
Certification Date: 2022-08-01
Certification Date: 2022-08-01
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1790417673 | ||||||||
| Enumeration Date | 2022-06-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 43 MADISON DR CLEMENTON, NJ 08021-2722 United States Phone: 856-449-3875 | Fax: | ||||||||
| Primary Practice Address | 43 MADISON DR CLEMENTON, NJ 08021-2722 United States Phone: 856-449-3875 | Fax: | ||||||||
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