Healthcare Provider Details

I. General information

NPI: 1699976670
Provider Name (Legal Business Name): DIGEN BALLAYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 LINDBERGH BLVD APARTMENT #2205
PHILADELPHIA PA
19153-2132
US

IV. Provider business mailing address

P.O. BOX 42753
PHILADELPHIA PA
19101
US

V. Phone/Fax

Practice location:
  • Phone: 267-975-6170
  • Fax:
Mailing address:
  • Phone: 267-975-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: