Healthcare Provider Details

I. General information

NPI: 1225495229
Provider Name (Legal Business Name): DYNAMIC KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N CENTRAL AVE # 340A
HARTSDALE NY
10530-1911
US

IV. Provider business mailing address

6 CRESTVIEW AVE
CORTLANDT MANOR NY
10567-5106
US

V. Phone/Fax

Practice location:
  • Phone: 914-428-5151
  • Fax:
Mailing address:
  • Phone: 914-588-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberP00502
License Number StateNY

VIII. Authorized Official

Name: ROBERTA LEVY
Title or Position: OWNER
Credential: OT
Phone: 914-428-5151