Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 25MA03382700 | NJ |
NPI | 1043253578 |
---|---|
Provider Name | Walid Baddoura |
First Address | Paterson, NJ 07503-2621 |
Second Address | Paterson, NJ 07503-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C56203 | (02) |