Healthcare Provider Details

I. General information

NPI: 1063376671
Provider Name (Legal Business Name): WONDIRFUL PLAY IL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE R
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

83 MERON RD
MONSEY NY
10952-2215
US

V. Phone/Fax

Practice location:
  • Phone: 732-353-1414
  • Fax:
Mailing address:
  • Phone: 732-353-1414
  • 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: HERSHEL FRIEDMAN
Title or Position: MANAGING MEMBERS
Credential:
Phone: 732-353-1414