Provider Demographics
NPI:1104071562
Name:BADU, IGOR (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:BADU
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BERGMAN DR
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1403
Mailing Address - Country:US
Mailing Address - Phone:516-569-9069
Mailing Address - Fax:
Practice Address - Street 1:53 BERGMAN DR
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1403
Practice Address - Country:US
Practice Address - Phone:516-569-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009832-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist