Individual
JILLIAN BALOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
26 E 22ND ST, NEW YORK, NY 10010-6107
(646) 847-1684
Mailing address
1216 CANDLEWOOD LN, SEA GIRT, NJ 08750-1717
(908) 723-0771
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
013237
NY
225200000X
Physical Therapy Assistant
Primary
40QB00388400
NJ
225200000X
Physical Therapy Assistant
PTA.6711
SC
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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