Organization
BALANCE FOOT AND ANKLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER MIRANDA DPM (PRESIDENT)
(845) 596-4745
Entity
Organization
Contact information
Practice address
611 MITCHEL FIELD WAY, GARDEN CITY, NY 11530-5057
(845) 596-4745
Mailing address
103 MITCHEL FIELD WAY, GARDEN CITY, NY 11530-5034
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04294551
—
NY
Enumeration date
07/03/2019
Last updated
07/03/2019
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