Provider Demographics
NPI:1396435731
Name:BIDIANA EXTENSIONS LLC
Entity type:Organization
Organization Name:BIDIANA EXTENSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIDEMI
Authorized Official - Middle Name:OMOBOLANLE
Authorized Official - Last Name:OMOYEFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-419-7399
Mailing Address - Street 1:1324 FOREST AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2044
Mailing Address - Country:US
Mailing Address - Phone:718-419-7399
Mailing Address - Fax:631-256-1353
Practice Address - Street 1:1324 FOREST AVE STE 104
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2044
Practice Address - Country:US
Practice Address - Phone:718-419-7399
Practice Address - Fax:631-256-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier