Provider Demographics
NPI:1003863358
Name:BADALOVA, DINA Y (NMD LAC)
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:Y
Last Name:BADALOVA
Suffix:
Gender:F
Credentials:NMD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8027 135TH ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:917-678-6461
Mailing Address - Fax:718-947-0407
Practice Address - Street 1:8027 135TH ST
Practice Address - Street 2:STE 1A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:917-678-6461
Practice Address - Fax:718-947-0407
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002908171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist