Balliet, Justin Kyle

Balliet, Justin Kyle is an individual health care provider with primary practice located at 1 Bartol Ave Ste 14 , Ridley Park PA 19078-2214. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Balliet, Justin Kyle can be contacted via phone (610) 521-9074.

Contact Information

Primary practice address
1 Bartol Ave Ste 14 Ridley Park PA 19078-2214
Phone: (610) 521-9074
Fax: (610) 521-9074
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X OA004604 Pennsylvania

Profile Details

NPI number 1316427651
LBN Legal business name Balliet, Justin Kyle
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2018
Last updated Oct 6th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316427651 NPPES
Pennsylvania MEDICAID 0015234460006
Pennsylvania Other 668795

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