Individual
DR. ETHAN BALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, RD
Contact information
Practice address
40 TEMPLE ST STE 7B, NEW HAVEN, CT 06510-2715
(203) 785-6060
Mailing address
40 TEMPLE ST STE 7B, NEW HAVEN, CT 06510-2715
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
1448
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14175906
CAQH PROVIDER ID
—
Enumeration date
01/09/2018
Last updated
01/09/2018
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