Healthcare Provider Details

I. General information

NPI: 1841065406
Provider Name (Legal Business Name): KINDER GROWTH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E OHIO ST
CHICAGO IL
60611-3265
US

IV. Provider business mailing address

3 MOET CT
JACKSON NJ
08527-3090
US

V. Phone/Fax

Practice location:
  • Phone: 201-249-0048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELI LEVIN
Title or Position: PRESIDENT
Credential:
Phone: 201-249-0048