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NPI Code Detail

MEDICARE: ISAK BADALOV DPM

MEDICARE:   ISAK  BADALOV  DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery PodiatristN006202NY

General Provider Information

NPI Number : 1396881264
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISAK BADALOV DPM
Provider Business Mailing Address
First Line : 14425 77TH AVE
Second Line :
City : FLUSHING
State : NY
Zip : 11367-3129
Country : US
Telephone Number : 917-239-5670
Fax Number :
Provider Business Practice Location Address
First Line : 8027 135TH ST
Second Line :
City : JAMAICA
State : NY
Zip : 11435-1029
Country : US
Telephone Number : 347-561-3120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 05/12/2010

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