Provider Demographics
NPI:1104308618
Name:BALLINGER, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 BREAKNECK RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4404
Mailing Address - Country:US
Mailing Address - Phone:856-803-4027
Mailing Address - Fax:
Practice Address - Street 1:444 BREAKNECK RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4404
Practice Address - Country:US
Practice Address - Phone:856-803-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
390200000XOtherSTUDENT