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General NPI Number Information
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NPI Number | 1336600428
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Entity Type | Individual
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Provider Name | NONNA BADALOVA MD,DO
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 5145 NESCONSET HWY STE 4
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2118
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Country | US
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Telephone | 347-493-2945
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Fax |
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Provider Business Mailing Address
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Address Line | 5145 NESCONSET HWY STE 4
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2118
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Country | US
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Telephone | 347-493-2945
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 316743
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License Number State | NY
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