Healthcare Provider Details

I. General information

NPI: 1083558092
Provider Name (Legal Business Name): THE LICE CHICKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 W SHORE DR
PUTNAM VALLEY NY
10579-1935
US

IV. Provider business mailing address

152 W SHORE DR
PUTNAM VALLEY NY
10579-1935
US

V. Phone/Fax

Practice location:
  • Phone: 914-302-2927
  • Fax:
Mailing address:
  • Phone: 914-302-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KILDUFF
Title or Position: LEAD TECHNICIAN/OWNER
Credential:
Phone: 914-302-2927