Provider Demographics
NPI:1659406908
Name:HOLDERBAUM, FLORA (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:FLORA
Middle Name:
Last Name:HOLDERBAUM
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:212-305-8555
Practice Address - Fax:646-317-5201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000732-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02474537Medicaid
NY02474537Medicaid