=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104964782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY V BADALAMENTI DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 BELLMORE AVE
-----------------------------------------------------
City | NORTH BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-5549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-781-2300
-----------------------------------------------------
Fax | 516-781-3865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1825 BELLMORE AVE
-----------------------------------------------------
City | NORTH BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-5549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-781-2300
-----------------------------------------------------
Fax | 516-781-3865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 11-2796816
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------