Active NPI
Nikolas Ryan Balas
- Rehabilitation Practitioner
- Coram, NY
National Provider Identifier
1801322375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 32468
- Practice address
- 3600 Route 112
Coram, NY 11727-4116 - Phone
- (631) 920-8500
- Fax
- (631) 920-8501
- NPI assigned
- May 3, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 32468 | NY | Primary |
Addresses
Primary practice location
3600 Route 112
Coram, NY 11727-4116
Mailing address
3600 Route 112
Coram, NY 11727-4116
Phone (631) 920-8500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32468 | NY | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1801322375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 ROUTE 112",
"city": "CORAM",
"state": "NY",
"postal_code": "117274116",
"telephone_number": "631-920-8500",
"fax_number": "631-920-8501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 ROUTE 112",
"city": "CORAM",
"state": "NY",
"postal_code": "117274116",
"telephone_number": "631-920-8500",
"fax_number": "631-920-8501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALAS",
"first_name": "NIKOLAS",
"middle_name": "RYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-03",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NY",
"license": "32468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coram, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.