Ethan Balk, PHD, RD

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

License

1448 Issued in CT

Practice address

40 Temple St Ste 7B
New Haven, CT 06510-2715

Phone

(203) 785-6060

NPI assigned

Jan 9, 2018

Last updated

Jan 9, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515456000000",
    "number": "1124535372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 TEMPLE ST STE 7B",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065102715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 TEMPLE ST STE 7B",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065102715",
            "telephone_number": "203-785-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALK",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "PHD, RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-09",
        "last_updated": "2018-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "CT",
            "license": "1448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER ID",
            "identifier": "14175906",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenifer Baldwin, LCSW
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• Kaitlin Balestriere, CRNA
• Elena Balica, M.D.
• Eroll Balingcongan
• Samuel Arthur Ball, PH.D.
• Cynthia Ballard
• Sarah Elizabeth Ballatori, MD
• Javier Ballester Gonzalez, MD
• Cristiana Baloescu, M.D.

• Metabolic Nutrition Registered Dietitian in New Haven, CT
• Providers in New Haven, CT by specialty
• Metabolic Nutrition Registered Dietitian in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.