Provider Demographics
NPI:1912507641
Name:BADECKER, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BADECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BEAMS TER
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2905
Mailing Address - Country:US
Mailing Address - Phone:732-804-9506
Mailing Address - Fax:
Practice Address - Street 1:369 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WATERFORD WORKS
Practice Address - State:NJ
Practice Address - Zip Code:08089
Practice Address - Country:US
Practice Address - Phone:609-561-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant