Provider Demographics
NPI:1053673228
Name:TEDESCHI, DENISE BONNIE
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:BONNIE
Last Name:TEDESCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHARLES LINDBERGH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3683
Mailing Address - Country:US
Mailing Address - Phone:516-227-8629
Mailing Address - Fax:516-227-8661
Practice Address - Street 1:60 CHARLES LINDBERGH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3683
Practice Address - Country:US
Practice Address - Phone:516-227-8629
Practice Address - Fax:516-227-8661
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator