Individual
MR. BRANDON J BALLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 454-8500
Mailing address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 454-8500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
015250
NY
363AM0700X
Medical Physician Assistant
Primary
015250
NY
Other
Enumeration date
10/19/2011
Last updated
01/02/2025
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