Mariusz Badzio
Individual provider Active NPI Early Intervention Provider Agency · Glendale, NY
NPI 1801504147 · NPPES record last updated Nov 7, 2022
Key facts
- NPI
- 1801504147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Early Intervention Provider Agency 252Y00000X
- License
- 3077560 (NY)
- Practice address
- 9050 Union Tpke Apt 17J
Glendale, NY 11385-8068 - Phone
- (718) 687-3370
- NPI assigned
- Nov 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3077560 | NY | MD | Early Intervention Provider Agency |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | 3077560 | NY | Yes |
Addresses
Primary practice location
9050 Union Tpke Apt 17J
Glendale, NY 11385-8068
Mailing address
9050 Union Tpke Apt 17J
Glendale, NY 11385-8068
Phone (718) 687-3370
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.