Provider Demographics
NPI:1407051089
Name:EDWARD S. BALLIS, M.D.
Entity Type:Organization
Organization Name:EDWARD S. BALLIS, M.D.
Other - Org Name:BALLIS PSYCHIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:NU
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-568-2811
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01086-0519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 W SILVER ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3628
Practice Address - Country:US
Practice Address - Phone:413-568-2811
Practice Address - Fax:413-572-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA765172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10418OtherHEALTH NEW ENGLAND
MA10418OtherHEALTH NEW ENGLAND
MAA47435Medicare UPIN