Provider Demographics
NPI:1336600428
Name:BADALOVA, NONNA (MD,DO)
Entity Type:Individual
Prefix:
First Name:NONNA
Middle Name:
Last Name:BADALOVA
Suffix:
Gender:F
Credentials:MD,DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-1635
Mailing Address - Country:US
Mailing Address - Phone:917-414-9977
Mailing Address - Fax:
Practice Address - Street 1:120 RICHARDS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-1635
Practice Address - Country:US
Practice Address - Phone:917-414-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine