Provider Demographics
NPI:1982778916
Name:BADAGLIACCA, ANNMARIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:ANNMARIE
Middle Name:
Last Name:BADAGLIACCA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 HIDDEN POND PATH
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792
Mailing Address - Country:US
Mailing Address - Phone:631-929-1353
Mailing Address - Fax:
Practice Address - Street 1:1743 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2649
Practice Address - Country:US
Practice Address - Phone:631-758-3100
Practice Address - Fax:631-758-2026
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYD06611-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant