Provider Demographics
NPI:1346681053
Name:RIVERDALE AUDIOLOGY PLLC
Entity Type:Organization
Organization Name:RIVERDALE AUDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:INGALLS
Authorized Official - Last Name:HOLDERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:718-543-4333
Mailing Address - Street 1:3050 CORLEAR AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5180
Mailing Address - Country:US
Mailing Address - Phone:718-543-4333
Mailing Address - Fax:718-543-4334
Practice Address - Street 1:3050 CORLEAR AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5180
Practice Address - Country:US
Practice Address - Phone:718-543-4333
Practice Address - Fax:718-543-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0007321231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02474537Medicaid
A300059007Medicare PIN