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General NPI Number Information
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NPI Number | 1356618466
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Entity Type | Individual
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Provider Name | LISA DILLMAN-BIDINOST PT
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Gender | Female
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Dates
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Enumeration Date | 11/18/2011
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 1153 BURGOYNE AVE STE 2
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City | FORT EDWARD
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State | NY
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Zip | 12828-1135
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Country | US
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Telephone | 518-581-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 3067 BIRCHTON RD
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City | BALLSTON SPA
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State | NY
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Zip | 12020-2036
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Country | US
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Telephone | 518-441-6179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 011019-1
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License Number State | NY
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