Healthcare Provider Details

I. General information

NPI: 1710120449
Provider Name (Legal Business Name): DIANA BADILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 S OYSTER BAY RD
BETHPAGE NY
11714-1030
US

IV. Provider business mailing address

857 S OYSTER BAY RD
BETHPAGE NY
11714-1030
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax: 516-342-2480
Mailing address:
  • Phone: 516-622-8888
  • Fax: 516-342-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number263219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: