Provider Demographics
NPI:1730103318
Name:BADIN, IRWIN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:J
Last Name:BADIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PORTLAND PL
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2810
Mailing Address - Country:US
Mailing Address - Phone:973-744-6006
Mailing Address - Fax:
Practice Address - Street 1:9 PORTLAND PL
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2810
Practice Address - Country:US
Practice Address - Phone:973-744-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1483103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ723943Medicare ID - Type UnspecifiedPROVIDER #