Provider Demographics
NPI:1821416173
Name:BALLIN, BRITTANY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BALLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:BALLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:240 E 27TH ST
Mailing Address - Street 2:APT 10N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9277
Mailing Address - Country:US
Mailing Address - Phone:212-721-0208
Mailing Address - Fax:
Practice Address - Street 1:240 E 27TH ST
Practice Address - Street 2:APT 10N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9277
Practice Address - Country:US
Practice Address - Phone:212-721-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017522-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY208311672Medicaid