Provider Demographics
NPI:1407823222
Name:FOUDY, DEIRDRE (DPT)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:FOUDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HAMPSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7630
Mailing Address - Country:US
Mailing Address - Phone:631-969-4295
Mailing Address - Fax:631-969-4296
Practice Address - Street 1:901 HAMPSHIRE RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7630
Practice Address - Country:US
Practice Address - Phone:631-969-4295
Practice Address - Fax:631-969-4296
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1013811-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY900061612OtherMAGNACARE
NY900061612OtherMAGNACARE