Provider Demographics
NPI:1588392617
Name:LYDER, BIANCA (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:LYDER
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 138TH ST APT 12D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2037
Mailing Address - Country:US
Mailing Address - Phone:917-209-5099
Mailing Address - Fax:
Practice Address - Street 1:10 E 138TH ST APT 12D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2037
Practice Address - Country:US
Practice Address - Phone:917-209-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22LY0113056224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist