Balk, Ethan

Balk, Ethan is an individual health care provider with primary practice located at 40 Temple St Ste 7B , New Haven CT 06510-2715. He recently has only one registered license in Dietary & Nutritional Service Providers / Nutrition, Metabolic, which is considered as his primary health care specialty. Balk, Ethan can be contacted via phone (203) 785-6060.

Contact Information

Primary practice address
40 Temple St Ste 7B New Haven CT 06510-2715
Phone: (203) 785-6060
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Nutrition, Metabolic 133VN1006X 1448 Connecticut

Profile Details

NPI number 1124535372
LBN Legal business name Balk, Ethan
Credentials PHD, RD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2018
Last updated Jan 9th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124535372 NPPES
Other 14175906 CAQH PROVIDER ID

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