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General NPI Number Information
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NPI Number | 1174838031
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Entity Type | Organization
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Legal Business Name | DIANA VOLLARO SLP LLC
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 3251 ROUTE 112 BLDG. 9, SUITE 3
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City | MEDFORD
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State | NY
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Zip | 11763-1446
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Country | US
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Telephone | 631-732-4794
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Fax | 631-732-0355
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Provider Business Mailing Address
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Address Line | 3251 ROUTE 112 BLDG. 9, SUITE 3
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City | MEDFORD
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State | NY
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Zip | 11763-1446
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Country | US
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Telephone | 631-732-4794
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Fax | 631-732-0355
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | DIANA VOLLARO
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Credential |
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Telephone | 516-984-2863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 016959-1
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License Number State | NY
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