Ethan Balk, PHD, RD
Individual provider Active NPI Metabolic Nutrition Registered Dietitian · New Haven, CT
NPI 1124535372 · NPPES record last updated Jan 9, 2018
Key facts
- NPI
- 1124535372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Metabolic Nutrition Registered Dietitian 133VN1006X
- License
- 1448 (CT)
- Practice address
- 40 Temple St Ste 7B
New Haven, CT 06510-2715 - Phone
- (203) 785-6060
- NPI assigned
- Jan 9, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1448 | CT | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Metabolic Nutrition Registered Dietitian | 133VN1006X | 1448 | CT | Yes |
Addresses
Primary practice location
40 Temple St Ste 7B
New Haven, CT 06510-2715
Mailing address
40 Temple St Ste 7B
New Haven, CT 06510-2715
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14175906 | Other | CAQH PROVIDER ID |
Other providers in New Haven, CT
- Jenifer Baldwin
- Allen E Bale
- Kaitlin Balestriere
- Elena Balica
- Eroll Balingcongan
- Samuel Arthur Ball
- Cynthia Ballard
- Sarah Elizabeth Ballatori
- Javier Ballester Gonzalez
- Cristiana Baloescu
All providers in New Haven, CT · Metabolic Nutrition Registered Dietitian in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.