Provider Demographics
NPI:1487201380
Name:PH BALANCE
Entity type:Organization
Organization Name:PH BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-350-2580
Mailing Address - Street 1:PO BOX 7885
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08404-7885
Mailing Address - Country:US
Mailing Address - Phone:609-350-2580
Mailing Address - Fax:
Practice Address - Street 1:1111 JORENE DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7545
Practice Address - Country:US
Practice Address - Phone:609-350-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTE KING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals