Provider Demographics
NPI:1295230852
Name:BALLINGER, GRAY CRUM
Entity type:Individual
Prefix:DR
First Name:GRAY
Middle Name:CRUM
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:GRAY
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:82-68 164TH ST.
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-883-3248
Mailing Address - Fax:718-883-6172
Practice Address - Street 1:82-68 164TH ST.
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-883-3248
Practice Address - Fax:718-883-6172
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314227208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice