Provider Demographics
NPI:1114142916
Name:BALLIN, MARY CATHERINE (GNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BALLIN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 171ST ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3328
Mailing Address - Country:US
Mailing Address - Phone:718-359-0197
Mailing Address - Fax:
Practice Address - Street 1:1484 1ST AVE
Practice Address - Street 2:WRIGHT CENTER ON AGING
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2304
Practice Address - Country:US
Practice Address - Phone:212-746-7000
Practice Address - Fax:212-717-8207
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340548363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology