Provider Demographics
NPI:1356618466
Name:DILLMAN-BIDINOST, LISA (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DILLMAN-BIDINOST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 BIRCHTON RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2036
Mailing Address - Country:US
Mailing Address - Phone:518-441-6179
Mailing Address - Fax:
Practice Address - Street 1:1153 BURGOYNE AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1135
Practice Address - Country:US
Practice Address - Phone:518-581-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011019-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist