Jillian Balog, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00388400 Issued in NJ

Practice address

26 E 22ND St
New York, NY 10010-6107

Phone

(646) 847-1684

NPI assigned

Jul 29, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spear Physical and Occupational Therapy, LLC

  • Physical Therapy Clinic/Center
  • New York, NY
  • NPI 1063454577
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1831928894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 CANDLEWOOD LN",
            "city": "SEA GIRT",
            "state": "NJ",
            "postal_code": "087501717",
            "telephone_number": "908-723-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 E 22ND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100106107",
            "telephone_number": "646-847-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALOG",
        "first_name": "JILLIAN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "PTA.6711",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "013237",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00388400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Channing Ballman, MD
• Edward Ballo, LMSW
• Mariam Ballout
• Casilda Balmaceda, M.D.
• Connor Balog, DMD
• Justine Balog, MOT, OTR/L
• Noemi Csilla Balogh, MD
• Dolapo Balogun
• Fiyinfolu Oladele Balogun, M.D., PH.D.
• Ifeoluwa Balogun, MD

• Physical Therapy Assistant in New York, NY
• Providers in New York, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.