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General NPI Number Information
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NPI Number | 1992595383
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Entity Type | Organization
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Legal Business Name | BOLZANO GROUP LLC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 6164 81ST ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1404
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Country | US
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Telephone | 917-495-2532
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Fax |
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Provider Business Mailing Address
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Address Line | 6164 81ST ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1404
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Country | US
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Telephone | 917-495-2532
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION TEACHER
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Name | ESYA YUSUPOVA
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Credential | MS.ED CERTIFIED
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Telephone | 917-495-2532
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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 |
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License Number State |
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