Provider Demographics
NPI:1134345671
Name:BALDIA, BRIAN LEVY (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEVY
Last Name:BALDIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2079
Mailing Address - Country:US
Mailing Address - Phone:607-321-7674
Mailing Address - Fax:607-239-6772
Practice Address - Street 1:2548 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2079
Practice Address - Country:US
Practice Address - Phone:607-321-7674
Practice Address - Fax:607-239-6772
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012250-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA563884Medicare ID - Type Unspecified