Organization
BIDIANA EXTENSIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABIDEMI OMOBOLANLE OMOYEFA (CEO)
(718) 419-7399
Entity
Organization
Contact information
Practice address
1324 FOREST AVE STE 104, STATEN ISLAND, NY 10302-2044
(718) 419-7399
(631) 256-1353
Mailing address
1324 FOREST AVE STE 104, STATEN ISLAND, NY 10302-2044
(718) 419-7399
(631) 256-1353
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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