Provider Demographics
NPI:1982785085
Name:BADRI, MAHER (MD)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:
Last Name:BADRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 BERGENWOOD AVE
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5349
Mailing Address - Country:US
Mailing Address - Phone:201-295-1616
Mailing Address - Fax:201-295-0032
Practice Address - Street 1:8915 BERGENWOOD AVE
Practice Address - Street 2:SUITE # 3
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5349
Practice Address - Country:US
Practice Address - Phone:201-295-1616
Practice Address - Fax:201-295-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA61587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7100108Medicaid
874193Medicare ID - Type Unspecified
NJ7100108Medicaid