Provider Demographics
NPI:1609547272
Name:BALTRUSITIS, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BALTRUSITIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORMA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1514
Mailing Address - Country:US
Mailing Address - Phone:631-332-3193
Mailing Address - Fax:
Practice Address - Street 1:230 NORMA AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-1514
Practice Address - Country:US
Practice Address - Phone:631-332-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.506781163WE0003X
FL9570913163WE0003X
NY692540-01163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency