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Contact Information

ETHAN BALK, PHD, RD
40 TEMPLE ST STE 7B
NEW HAVEN, CT06510-2715
 Phone: 203-785-6060
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nutrition, Metabolic

133VN1006X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for ETHAN BALK · (Male)

NPI # 1124535372
Status Active
Credentials PHD, RD
Entity Individual
Enumeration date 01/09/2018
Last updated 01/09/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • CT License # 1448
  • Other 14175906 CAQH PROVIDER ID
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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