Balanced Well Medical Network

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA09551100 Issued in NJ

Legal business name

BALANCED WELL MEDICAL NETWORK

Practice address

23-08 Maple Ave
Fair Lawn, NJ 07410-1583

Phone

(201) 794-4500

Fax

(201) 794-4502

NPI assigned

May 5, 2016

Organization subpart

Yes

Parent organization

BALANCED WELL MEDICALAs reported in NPPES

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

Authorized official

Name

Dr. Roth Leon Riley, MD

Title

Director

Phone

(201) 794-4500

Specialties & licenses 1

Addresses

Part of

Balanced Well Medical

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Balanced Well Medical

  • Internal Medicine Physician
  • Fair Lawn, NJ
  • NPI 1154704831
  NPPES parent name

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

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462406400000",
    "number": "1295181584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23-08 MAPLE AVE",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074101583",
            "telephone_number": "201-794-4500",
            "fax_number": "201-794-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23-08 MAPLE AVE",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074101583",
            "telephone_number": "201-794-4500",
            "fax_number": "201-794-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED WELL MEDICAL NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BALANCED WELL MEDICAL",
        "enumeration_date": "2016-05-05",
        "last_updated": "2016-05-05",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "ROTH",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "201-794-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA09551100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Balance and Memory Medical LLC
• Balance Well Labs
• Balance Well Therapies LLC
• Balanced Well Acupuncture
• Balanced Well Medical
• Balanced Well Podiatry
• Sundri Balani
• Richard C. Balch, P.T.
• Jessica Eve Ballester, LCSW
• Joshua D Balog, M.D.

• Family Medicine Physician in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; 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.