Healthcare Provider Details

I. General information

NPI: 1730762535
Provider Name (Legal Business Name): KINDER GROWTH FLOORTIME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUNTER DR
LAKEWOOD NJ
08701-4755
US

IV. Provider business mailing address

1 HUNTER DR
LAKEWOOD NJ
08701-4755
US

V. Phone/Fax

Practice location:
  • Phone: 201-249-0048
  • Fax:
Mailing address:
  • Phone: 201-249-0048
  • 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: TIRTZA KATZ
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 917-536-0255