McReynald Balthazar
Individual provider Active NPI Registered Nurse · Medford, NY
NPI 1962859488 · NPPES record last updated May 16, 2016
Key facts
- NPI
- 1962859488
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 5184743817 (NY)
- Practice address
- 31 Industrial Blvd
Medford, NY 11763-2220 - Phone
- (631) 924-4411
- NPI assigned
- May 16, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5184743817 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Yaphank Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 5184743817 | NY | Yes |
Addresses
Primary practice location
31 Industrial Blvd
Medford, NY 11763-2220
Mailing address
31 Industrial Blvd
Medford, NY 11763-2220
Phone (631) 924-4411
Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2016. 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.