# BLUE BALLOON PA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518563709
- **Authorized official:** DOVID SUSSMAN (MEMBER)
- **Authorized official phone:** (201) 216-9500

## Contact information

- **Practice address:** 175 BELGROVE DR, KEARNY, NJ 07032-1507
- **Practice address phone:** (201) 216-9500
- **Mailing address:** 175 BELGROVE DR, KEARNY, NJ 07032-1507

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |

## Other

- **Enumeration date:** 12/11/2020
- **Last updated:** 12/11/2020