Healthcare Provider Details

I. General information

NPI: 1508705641
Provider Name (Legal Business Name): KINDER GROWTH PENN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOET CT
JACKSON NJ
08527-3090
US

IV. Provider business mailing address

3 MOET CT
JACKSON NJ
08527-3090
US

V. Phone/Fax

Practice location:
  • Phone: 973-405-4707
  • 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: SARI LEVIN
Title or Position: OWNER
Credential:
Phone: 973-405-4707