Provider Demographics
NPI:1730313529
Name:VARILLAS-ARQUINIGO, IDANIA (MS- SLP)
Entity Type:Individual
Prefix:MRS
First Name:IDANIA
Middle Name:
Last Name:VARILLAS-ARQUINIGO
Suffix:
Gender:F
Credentials:MS- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 ALDERTON ST
Mailing Address - Street 2:APT. 2P
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2743
Mailing Address - Country:US
Mailing Address - Phone:646-289-2603
Mailing Address - Fax:
Practice Address - Street 1:9745 QUEENS BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2116
Practice Address - Country:US
Practice Address - Phone:718-830-9274
Practice Address - Fax:718-830-9276
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist