Healthcare Provider Details

I. General information

NPI: 1457265704
Provider Name (Legal Business Name): ROBERT BRIAN BALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 FELLOWSHIP RD
MOUNT LAUREL NJ
08054-3416
US

IV. Provider business mailing address

1101 MILLSTREAM DR
CHERRY HILL NJ
08002-1054
US

V. Phone/Fax

Practice location:
  • Phone: 856-581-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number2122
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: