Provider Demographics
NPI:1821538489
Name:BADALOV, MARINA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:BADALOV
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6441 SAUNDERS ST APT 407
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3228
Mailing Address - Country:US
Mailing Address - Phone:347-977-8073
Mailing Address - Fax:
Practice Address - Street 1:6441 SAUNDERS ST APT 407
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3228
Practice Address - Country:US
Practice Address - Phone:347-977-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704973-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse