Basic Information
| Provider Information | |||||||||
| NPI: | 1174775449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLINGER | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 CLARKSON AVE # 1228 | ||||||||
| Address2: | DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182454795 | ||||||||
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| Practice Location | |||||||||
| Address1: | 450 CLARKSON AVE # 1228 | ||||||||
| Address2: | DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182454795 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2008 | ||||||||
| LastUpdateDate: | 08/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 125-064394 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 125-064394 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | A111025 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 265780-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 265780-1 | 01 | NY | NY MEDICAL LICENSE | OTHER | 125-064394 | 01 | IL | STATE LISCENSE NUMBER | OTHER | A111025 | 01 | CA | CA MEDICAL LICENSE | OTHER |