Provider Demographics
NPI:1174866065
Name:JOSEPH BALLARO MD PC
Entity Type:Organization
Organization Name:JOSEPH BALLARO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-687-1520
Mailing Address - Street 1:2933 VAUXHALL RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-1260
Mailing Address - Country:US
Mailing Address - Phone:908-687-1520
Mailing Address - Fax:908-687-1989
Practice Address - Street 1:2933 VAUXHALL RD
Practice Address - Street 2:SUITE 28
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1260
Practice Address - Country:US
Practice Address - Phone:908-687-1520
Practice Address - Fax:908-687-1989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH BALLARO MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-29
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05662500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4594401Medicaid