Healthcare Provider Details

I. General information

NPI: 1114170834
Provider Name (Legal Business Name): HOUSE CALLS OF NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2008
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ELM AVE
FANWOOD NJ
07023-1203
US

IV. Provider business mailing address

PO BOX 122
SCOTCH PLAINS NJ
07076-0122
US

V. Phone/Fax

Practice location:
  • Phone: 908-279-3477
  • Fax: 908-345-6111
Mailing address:
  • Phone: 908-279-3477
  • Fax: 908-345-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05733100
License Number StateNJ

VIII. Authorized Official

Name: DR. DOUGLAS BALLAN
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 908-279-3477