Healthcare Provider Details

I. General information

NPI: 1922394576
Provider Name (Legal Business Name): JOSEPH NUNZIO BADOLATO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HURFFVILLE CROSSKEYS RD
SEWELL NJ
08080-0000
US

IV. Provider business mailing address

454 HURFFVILLE CROSS KEYS RD
TURNERSVILLE NJ
08012-2448
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-2500
  • Fax:
Mailing address:
  • Phone: 856-218-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB09398500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: