Provider Demographics
NPI:1790045110
Name:BOBADILLA, NIKOLE K (MD)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:K
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIKOLE
Other - Middle Name:KATHERINA
Other - Last Name:METCALF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:375 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2750
Practice Address - Country:US
Practice Address - Phone:973-731-7707
Practice Address - Fax:973-669-0277
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00718207V00000X
390200000X
NJ25MA11180400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program