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General NPI Number Information
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NPI Number | 1669817698
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Entity Type | Individual
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Provider Name | AVON D BODDIN SPECIAL EDUCATION
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Gender | Female
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 88-48 78 STREET
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City | WOODHAVEN
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State | NY
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Zip | 11421
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Country | US
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Telephone | 718-296-8810
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Fax |
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Provider Business Mailing Address
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Address Line | 8848 78TH ST
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City | WOODHAVEN
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State | NY
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Zip | 11421-2310
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Country | US
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Telephone | 718-296-8810
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 693099121
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License Number State | NY
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