Michael Baladi

Key facts

NPI

1619645009

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X

License

28RI04198700 (NJ)

Practice address

397 Route 46 W
Fairfield, NJ 07004-1967

Phone

(862) 210-3980

NPI assigned

Sep 1, 2021

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)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 1, 2021.

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1619645009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 SLOPING HILL TER",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074704212",
            "telephone_number": "973-207-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 ROUTE 46 W",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070041967",
            "telephone_number": "862-210-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALADI",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NJ",
            "license": "28RI04198700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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