Provider Demographics
NPI:1174676886
Name:BADARACCO-APOLITO, MARIE R (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:R
Last Name:BADARACCO-APOLITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1937
Mailing Address - Country:US
Mailing Address - Phone:973-783-5033
Mailing Address - Fax:973-746-2604
Practice Address - Street 1:88 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1937
Practice Address - Country:US
Practice Address - Phone:973-783-5033
Practice Address - Fax:973-746-2604
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA020578002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5263603Medicaid
PA050328Medicare ID - Type Unspecified
NJ5263603Medicaid
NJ446540Medicare ID - Type Unspecified