MEDICARE: AJAY BALLADIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	407098	NY
2	363LF0000X	Family Nurse Practitioner	338235	NY

General Provider Information

NPI Number	:	1134541733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJAY BALLADIN

Provider Business Mailing Address
First Line	:	3 SYLVIA RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-6424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 SYLVIA RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-6424
Country	:	US
Telephone Number	:	516-644-0120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	03/22/2026

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Directions to “ AJAY BALLADIN ” Practice Location

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