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General NPI Number Information
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NPI Number | 1467544015
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Entity Type | Organization
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Legal Business Name | WALID J. BADDOURA M.D.,P.A.
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 716 BROAD ST
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City | CLIFTON
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State | NJ
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Zip | 07013-1645
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Country | US
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Telephone | 973-777-7733
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Fax | 973-777-0669
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Provider Business Mailing Address
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Address Line | 716 BROAD ST
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City | CLIFTON
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State | NJ
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Zip | 07013-1645
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Country | US
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Telephone | 973-777-7733
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Fax | 973-777-0669
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Authorized Official
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Title or Position | OWNER
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Name | WALID J BADDOURA
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Credential | M.D.
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Telephone | 973-777-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA33827
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License Number State | NJ
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