# BALANCE WELL LABS

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BALANCED WELL MEDICAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629423124
- **Legal business name:** BALANCED WELL MEDICAL
- **Authorized official:** DR. ROTH RILEY MD (DIRECTOR)
- **Authorized official phone:** (201) 794-4500

## Contact information

- **Practice address:** 23-08 MAPLE AVE, FAIR LAWN, NJ 07410
- **Practice address phone:** (201) 974-4500
- **Practice address fax:** (201) 974-4502
- **Mailing address:** 23-08 MAPLE AVE, FAIR LAWN, NJ 07410
- **Mailing address phone:** (201) 794-4500
- **Mailing address fax:** (201) 794-4502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 25MA09551100 | NJ | Yes |

## Other

- **Enumeration date:** 05/03/2016
- **Last updated:** 05/03/2016