Provider Demographics
NPI:1871771055
Name:BALSAMINI, DAVID C (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:BALSAMINI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1914
Practice Address - Country:US
Practice Address - Phone:973-394-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02505700183500000X
NY0432241183500000X
CT10483183500000X
FLPS41809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0432241OtherPHARMACIST
NJ28RI02505700OtherPHARMACIST
FLPS41809OtherPHARMACIST
CT10483OtherPHARMACIST