Provider Demographics
NPI:1144801549
Name:BALLARD, WEBSTER J
Entity Type:Individual
Prefix:
First Name:WEBSTER
Middle Name:J
Last Name:BALLARD
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 1:2225 LACOMBE AVE APT 9I
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1506
Mailing Address - Country:US
Mailing Address - Phone:646-309-3135
Mailing Address - Fax:
Practice Address - Street 1:2225 LACOMBE AVE APT 9I
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1506
Practice Address - Country:US
Practice Address - Phone:646-309-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY394963225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor