Provider Demographics
NPI:1194497198
Name:BADIE, ALEXANDRA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BADIE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1007
Mailing Address - Country:US
Mailing Address - Phone:201-577-8156
Mailing Address - Fax:
Practice Address - Street 1:311 BAY AVE STE 20
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1607
Practice Address - Country:US
Practice Address - Phone:973-746-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00665500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical