| Dr Ethan Balk, PHD, RD | |
|
40 Temple St Ste 7b, New Haven, CT 06510-2715 | |
| (203) 785-6060 | |
| Not Available |
| Full Name | Dr Ethan Balk |
|---|---|
| Gender | Male |
| Speciality | Dietitian, Registered - Nutrition, Metabolic |
| Location | 40 Temple St Ste 7b, New Haven, Connecticut |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124535372 | NPI | - | NPPES |
| 14175906 | Other | CAQH PROVIDER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133VN1006X | Dietitian, Registered - Nutrition, Metabolic | 1448 (Connecticut) | Primary |
| Provider Name | Northeast Medical Group Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1043278351 PECOS PAC ID: 1254233836 Enrollment ID: O20040123000522 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Ethan Balk, PHD, RD 40 Temple St Ste 7b, New Haven, CT 06510-2715 Ph: () - | Dr Ethan Balk, PHD, RD 40 Temple St Ste 7b, New Haven, CT 06510-2715 Ph: (203) 785-6060 |
Taylor Kingston, Dietitian Medicare: Not Enrolled in Medicare Practice Location: 20 York St, Food And Nutrition Epb806, New Haven, CT 06510 Phone: 203-688-9185 | |
Mrs. Nataliya Putnam, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 33 Kneeland Rd, New Haven, CT 06512 Phone: 781-315-9185 | |
Paulina Rose, RD CDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2 Church St S, Suite 511, New Haven, CT 06519 Phone: 203-764-9199 Fax: 203-764-9149 | |
Mary Savoye, RD Dietitian Medicare: Medicare Enrolled Practice Location: 2 Church St S, Suite 404, New Haven, CT 06519 Phone: 203-764-6767 Fax: 203-764-6748 | |
Kelly Elizabeth Gaffney, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 374 Grand Ave, New Haven, CT 06513 Phone: 203-777-7411 | |
Madeline Susan Cole, RDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 20 York St, New Haven, CT 06510 Phone: 203-688-7838 | |
Amy Ralph, Dietitian Medicare: Medicare Enrolled Practice Location: Yale New Haven Hospital, 20 York St, New Haven, CT 06510 Phone: 203-688-2422 |