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General NPI Number Information
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NPI Number | 1114280393
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Entity Type | Individual
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Provider Name | MS. ROZA BADALOVA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 7238 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11367-2408
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Country | US
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Telephone | 718-851-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MOWBRAY DR
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City | KEW GARDENS
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State | NY
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Zip | 11415-1437
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Country | US
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Telephone | 718-309-8988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 171M00000X-CASE
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License Number State |
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