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General NPI Number Information
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NPI Number | 1114170834
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Entity Type | Organization
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Legal Business Name | HOUSE CALLS OF NJ
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Dates
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Enumeration Date | 10/25/2008
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 45 ELM AVE
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City | FANWOOD
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State | NJ
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Zip | 07023-1203
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Country | US
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Telephone | 908-279-3477
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Fax | 908-345-6111
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Provider Business Mailing Address
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Address Line | PO BOX 122
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City | SCOTCH PLAINS
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State | NJ
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Zip | 07076-0122
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Country | US
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Telephone | 908-279-3477
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Fax | 908-345-6111
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. DOUGLAS BALLAN
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Credential |
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Telephone | 908-279-3477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA05733100
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License Number State | NJ
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