Provider Demographics
NPI:1417141664
Name:BADALOV, NISON L (MD)
Entity type:Individual
Prefix:DR
First Name:NISON
Middle Name:L
Last Name:BADALOV
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:902 QUENTIN RD
Mailing Address - Street 2:SEVENTH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2214
Mailing Address - Country:US
Mailing Address - Phone:718-336-3900
Mailing Address - Fax:718-336-3990
Practice Address - Street 1:902 QUENTIN RD
Practice Address - Street 2:SEVENTH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2214
Practice Address - Country:US
Practice Address - Phone:718-336-3900
Practice Address - Fax:718-336-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2015-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY242278207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03071010Medicaid
NY03071010Medicaid
NYA400007218Medicare PIN