# ILYA BADALOV PHYSICIAN PC

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

## Provider details

- **NPI number:** 1962655167
- **Authorized official:** ILYA BADALOV MD (PRESIDENT)
- **Authorized official phone:** (718) 847-9329

## Contact information

- **Practice address:** 13511 78TH DR, FLUSHING, NY 11367-3235
- **Practice address phone:** (718) 847-9329
- **Mailing address:** 13511 78TH DR, FLUSHING, NY 11367-3235
- **Mailing address phone:** (718) 847-9329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208C00000X | Colon & Rectal Surgery Physician | — | NULL | Yes |
| 208C00000X | Colon & Rectal Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/31/2008
- **Last updated:** 10/31/2008