# NISON L BADALOV MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528485752
- **Authorized official:** NISON L. BADALOV MD (OWNER)
- **Authorized official phone:** (718) 520-0857

## Contact information

- **Practice address:** 107-21 QUEENS BLVD, SUITE 4, FOREST HILLS, NY 11375-4451
- **Practice address phone:** (718) 520-0857
- **Practice address fax:** (718) 520-9099
- **Mailing address:** 107-21 QUEENS BLVD, SUITE 4, FOREST HILLS, NY 11375-4451
- **Mailing address phone:** (718) 520-0857
- **Mailing address fax:** (718) 520-9099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | 242278 | NY | Yes |

## Other

- **Enumeration date:** 03/26/2014
- **Last updated:** 03/26/2014