1700971041 NPI number — JOSEPH BALLARO M.D.

Table of content: JOSEPH BALLARO M.D. (NPI 1700971041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700971041 NPI number — JOSEPH BALLARO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLARO
Provider First Name:
JOSEPH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700971041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-6457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2933 VAUXHALL RD
Provider Second Line Business Practice Location Address:
SUITE 28
Provider Business Practice Location Address City Name:
VAUXHALL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07088-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-687-1520
Provider Business Practice Location Address Fax Number:
908-687-1989
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA56625 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4594401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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