Provider Demographics
NPI:1982779310
Name:DR CHARLES J BADGER II, GENERAL PRACTIONER, PC
Entity Type:Organization
Organization Name:DR CHARLES J BADGER II, GENERAL PRACTIONER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BADGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-250-3700
Mailing Address - Street 1:156 CORLISS AVE APT 708
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2071
Mailing Address - Country:US
Mailing Address - Phone:917-250-3700
Mailing Address - Fax:607-797-1460
Practice Address - Street 1:156 CORLISS AVE APT 708
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2071
Practice Address - Country:US
Practice Address - Phone:917-250-3700
Practice Address - Fax:607-797-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209797282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY75L851Medicare ID - Type Unspecified
NYG78148Medicare UPIN