Provider Demographics
NPI:1407001175
Name:BADAMI, CHIRAG (MD)
Entity type:Individual
Prefix:
First Name:CHIRAG
Middle Name:
Last Name:BADAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3100N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-909-9018
Practice Address - Fax:914-909-9028
Is Sole Proprietor?:No
Enumeration Date:2008-11-23
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445471208G00000X
NJ25MA09342000208G00000X
NY283866208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027347700001Medicaid
NJ0376132Medicaid
PA2715831OtherHIGHMARK BLUE SHIELD
PA3882363000OtherKEYSTONE IBC
NJ0376132Medicaid
PA239077R8CMedicare PIN