Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N006202 | NY |
NPI | 1396881264 |
---|---|
Provider Name | Isak Badalov |
First Address | Flushing, NY 11367-3129 |
Second Address | Jamaica, NY 11435-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 12/05/2010 |