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General NPI Number Information
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NPI Number | 1992177315
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Entity Type | Organization
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Legal Business Name | BIDICO SPEECH LANGUAGE PATHOLOGIST, PLLC
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Dates
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Enumeration Date | 10/25/2015
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Last Update Date | 10/25/2015
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Provider Practice Location Address
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Address Line | 11701 PARK LN S APT D3F
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City | RICHMOND HILL
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State | NY
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Zip | 11418-1052
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Country | US
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Telephone | 646-326-1633
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Fax |
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Provider Business Mailing Address
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Address Line | 11701 PARK LN S APT D3F
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City | RICHMOND HILL
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State | NY
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Zip | 11418-1052
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Country | US
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Telephone | 646-326-1633
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. LAURA COSTA
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Credential | MS/SLP
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Telephone | 646-326-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 015479
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License Number State | NY
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