Provider Demographics
NPI:1770637175
Name:BALON, ELLEN MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:BALON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:5530 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-636-1947
Mailing Address - Fax:716-636-1369
Practice Address - Street 1:5530 SHERIDAN DRIVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-636-1947
Practice Address - Fax:716-636-1369
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF3302221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560297005OtherHEALTH NOW NEW YORK INC
NY9512471OtherINDEPENDENT HEALTH
NY9512471OtherINDEPENDENT HEALTH