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General NPI Number Information
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NPI Number | 1710314984
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Entity Type | Individual
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Provider Name | MISS LYN JONSON BALLENER
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Gender | Female
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 824 55TH STREET (BET. 8TH & 9TH AVE.) BROOKLYN
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City | NY
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State | NY
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Zip | 11220
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Country | US
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Telephone | 718-686-1733
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Fax |
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Provider Business Mailing Address
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Address Line | 64 TUERS AVE #2C JERSEY CITY
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City | JERSEY CITY
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State | NJ
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Zip | 07306-3250
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Country | US
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Telephone | 201-850-0619
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 032523
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License Number State | NY
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