Provider Demographics
NPI:1174838031
Name:DIANA VOLLARO SLP LLC
Entity Type:Organization
Organization Name:DIANA VOLLARO SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-984-2863
Mailing Address - Street 1:3251 ROUTE 112
Mailing Address - Street 2:BLDG. 9, SUITE 3
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1446
Mailing Address - Country:US
Mailing Address - Phone:631-732-4794
Mailing Address - Fax:631-732-0355
Practice Address - Street 1:3251 ROUTE 112
Practice Address - Street 2:BLDG. 9, SUITE 3
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1446
Practice Address - Country:US
Practice Address - Phone:631-732-4794
Practice Address - Fax:631-732-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016959-1261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech