Healthcare Provider Details

I. General information

NPI: 1861756116
Provider Name (Legal Business Name): ALL ABOUT KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

5 BRAKEMAN CT
HIGHTSTOWN NJ
08520-3064
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-0962
  • Fax:
Mailing address:
  • Phone: 609-443-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number884497991
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number884497991
License Number StateNY

VIII. Authorized Official

Name: MS. MARIELA PENA
Title or Position: COMPLIANCE COORDINATOR
Credential:
Phone: 718-522-7300