Provider Demographics
NPI:1548308125
Name:BOUSSIDAN, BECKI NAOMI (MS ED)
Entity type:Individual
Prefix:MRS
First Name:BECKI
Middle Name:NAOMI
Last Name:BOUSSIDAN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:BECKI
Other - Middle Name:NAOMI
Other - Last Name:ZLATKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:7 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4603
Mailing Address - Country:US
Mailing Address - Phone:917-783-5340
Mailing Address - Fax:516-935-2867
Practice Address - Street 1:538 BROADHOLLOW RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3676
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist